Vlada · Research · 2026-10-18 · observed
Jardiance needs approval first for 23% of Medicare Advantage drug plan members, up from none.
For 2027, how many Medicare Advantage drug plan members need approval first for Jardiance, who added the step, and how much does it depend on the state?
| State | 2026 | 2027 |
|---|---|---|
| VT | 0 | 100 |
| MT | 0 | 97.3 |
| NH | 0 | 66.7 |
| MI | 0 | 47.2 |
| LA | 0 | 45.4 |
| MS | 0 | 44 |
| KY | 0 | 43.5 |
| WV | 0 | 39.3 |
| AR | 0 | 38.2 |
| SC | 0 | 38.1 |
| IL | 0 | 37.9 |
| VA | 0 | 36.4 |
| FL | 0 | 35.7 |
| GA | 0 | 35.6 |
| OK | 0 | 34.8 |
| NM | 0 | 34.8 |
| NV | 0 | 34.5 |
| IN | 0 | 32.4 |
| KS | 0 | 27.6 |
| UT | 0 | 25.7 |
| MO | 0 | 25.3 |
| TN | 0 | 24.5 |
| NC | 0 | 24.3 |
| AZ | 0 | 24.3 |
| CO | 0 | 23.9 |
| TX | 0 | 23 |
| AL | 0 | 21.9 |
| PA | 0 | 21.6 |
| WA | 0 | 19.6 |
| MD | 0 | 18.2 |
| WI | 0 | 16.4 |
| OH | 0 | 15.8 |
| WY | 0 | 15.5 |
| ME | 0 | 13.9 |
| IA | 0 | 13.8 |
| HI | 0 | 13.4 |
| MN | 0 | 11.9 |
| NE | 0 | 11.9 |
| DE | 0 | 10.4 |
| NJ | 0 | 10.3 |
| ID | 0 | 8.1 |
| CA | 0 | 4.7 |
| OR | 0 | 4.1 |
| DC | 0 | 3.8 |
| NY | 0 | 2.7 |
| CT | 0 | 2.2 |
| MA | 0 | 1.8 |
| SD | 0 | 0 |
| RI | 0 | 0 |
| PR | 0 | 0 |
| ND | 0 | 0 |
Share of members whose MA-PD plan requires prior authorization on every listed form of Jardiance (brand empagliflozin; no generic is listed), 2027 first edition vs September 2026, weighted by September 2026 enrollment, members whose plan continues into 2027; states by county of residence. · CMS Monthly Prescription Drug Plan Formulary and Pharmacy Network Information (2026-09; 2026-10, first plan year 2027); CMS monthly enrollment by plan and by contract, plan, state and county, September 2026; CMS 2027 plan crosswalk; CMS fact sheet, Negotiated Prices for Initial Price Applicability Year 2026 (August 2024); CMS Part D Spending by Drug 2024. Vlada analysis. · 51 rows
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- The formulary file says prior authorization is required. It does not give the criteria, whether it applies only to new prescriptions, the transition supply plans must give current users, or how often plans approve. The post says 'approval first', never 'denied'.
- Jardiance (empagliflozin) and dapagliflozin are both SGLT2 inhibitors used for diabetes, heart failure and kidney disease, but they are different drugs; the post does not say one replaces the other. Generic dapagliflozin is sold as generic versions of Farxiga.
- No reason is claimed for Humana's choice. The file shows the rule only.
- The negotiated price (maximum fair price) is what Medicare plans pay per 30-day supply, not what a member pays; the member's cost depends on the plan's tier and cost sharing (Jardiance stays on tier 3 at Humana).
- MA-PD only (H and R contracts). Stand-alone drug plans and employer group plans are excluded.
- Members are September 2026 enrollment in plans carried into 2027 by the CMS crosswalk, one successor per 2026 plan; new 2027 members and open-enrollment switches are not counted.
- State figures use county enrollment by state of residence; CMS suppresses cells under 11 members. Small states (Vermont 100%, Montana 97%, New Hampshire 67%) have higher shares than any state on the figure but fewer than 100,000 matched members.
- The 2027 file is CMS's first edition (October 2026); CMS posts corrections monthly and the January 2027 file can differ.
- Humana is 92.4% of the members whose plan adds the step; Corewell (Priority Health, Michigan), UPMC (Pennsylvania) and HealthPartners add it too.
- Humana's 5.6 million are members in plans that continue into 2027 (6.06 million in its individual MA-PD plans in September 2026).
- Generic dapagliflozin sits on tier 3 at Humana, the same tier as Jardiance. In 2026 about half of members' plans did not list brand Farxiga at all; UnitedHealthcare lists it for 2027 with step therapy.
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