UnitedHealthcare adds an approval step to 4 common pills for 2027. Humana raises 3 a tier.

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• The formulary file says prior authorization is required and sets the tier. It does not give the approval criteria, whether the step applies only to new prescriptions, the transition supply plans must give current users, or how often plans approve. The post says 'approval step', never 'denied'.
• The prior authorization flag can carry age-based safety checks on high-risk drugs for older adults; the file does not separate them.
• Humana MA-PD plans offer 90-day supplies on tier 4 in 2027; the 30-day tier 4 limit printed in a Humana stand-alone drug plan guide does not apply here.
• MA-PD only: H and R contracts in the 2027 file. Stand-alone drug plans (PDPs) and employer group plans are excluded.
• Members are September 2026 enrollment in plans carried into 2027 by the CMS crosswalk (renewals and consolidations), one successor per 2026 plan (lowest contract and plan id). New 2027 members and open-enrollment switches are not counted.
• Insurers are grouped by CMS parent organization (UnitedHealth Group; Humana). The grid shows the tier and cost share on each insurer's plans; UnitedHealthcare's approval step covers 99.4% of its members, not every plan.
• State figures (slide 2) use county enrollment by state of residence; CMS suppresses cells under 11 members. Alaska has no county-file members in matched continuing MA-PD plans and is not shown. Puerto Rico is not on the map.
• The 2027 file is CMS's first edition (October 2026); CMS posts corrections monthly and the January 2027 file can differ.
• No reason is claimed for any insurer's choice. The Beers Criteria line is context, not a measured cause.
• Version 1 of this drop (merged as #3834, offer email cancelled before sending) said Humana 'asks first for none' without the tier change. This version adds it.
• Cost cells show the most common cost-share designs for that tier across the insurer's plans (30-day supply, standard retail, initial coverage stage), not one plan. Preferred-pharmacy cost sharing is not offered in almost all of these plans.
• Dollar figures are derived, not observed: they use 2024 total Part D cost per prescription (plan plus patient), which mixes 30- and 90-day fills, is not any plan's negotiated price, and may run high for 2027 (lorazepam's cost per unit fell 16% in 2024).
• Only lorazepam costs more at Humana. Clonazepam and temazepam cost about the same before the deductible (members already paid about the drug's price under a $30 to $47 copay) and less after it. Pregabalin stays on tier 3 at Humana and gets cheaper (17% to 19% instead of a $30 to $47 copay capped at about $26.54).
• A member who takes only lorazepam (about $78 a year) would not meet a deductible of about $600, so for them 'until the deductible is met' means the whole year.
• UnitedHealthcare's lorazepam cost share fell for 2027 (mostly a $0 to $6 copay, from a mix of $0 to $12 copays and 25% coinsurance).
• Drugs are matched by active ingredient through RxNorm (single-ingredient products only). Tier is the lowest tier across all of the drug's listed forms.
• Humana's 2026 tier 3 and 2027 pregabalin cost shares apply after the deductible for about 54% and 57% of members; 14% of Humana members had 25% coinsurance on tier 3 in 2026 rather than a copay.
• Cell cost lines describe the change before the deductible for most of the insurer's members (per member, 2024 prices; same = within 50 cents). After the deductible: at UnitedHealthcare, 49% of members pay a few dollars more for pregabalin (up to about $6.60) and 26% up to $3 more for temazepam; at Humana, 54% pay less for lorazepam and most pay less for the other three. 5% of UnitedHealthcare members pay more for lorazepam before the deductible.
• Humana lorazepam: 'up to $6.50 more' holds at 2024 prices or lower; how many pay more depends on the real 30-day price. About 44% of Humana members had a $0 or $1 copay and pay more at any price; the 42% with a $5 copay pay a dollar or two more, or the same, depending on the price. Extra Help members pay the lower of their Extra Help copay and the plan's cost share, so a tier change can move them by a dollar or two.