Medicare Part D Drug Coverage
Plan Comparison & Formulary Data
Medicare Part D provides outpatient prescription drug coverage to over 51 million Americans. Plans vary widely in premiums, formularies, and cost-sharing. InsureWith.ai aggregates formulary and pricing data so you can compare plans, check drug coverage, and find the lowest out-of-pocket costs in your state.
How Part D works
Every Part D plan follows the same four-phase benefit structure. Your costs change as you move through each phase during the calendar year.
Deductible
You pay 100% of drug costs until you reach the annual deductible. Some plans cover certain generics before the deductible.
Initial Coverage
You pay copays or coinsurance (typically 25%) while your plan covers the rest. Costs vary by drug tier and plan.
Coverage Gap
Previously the "donut hole." Manufacturer discounts and plan contributions count toward your out-of-pocket threshold.
Catastrophic
You pay $0 for covered drugs for the rest of the year. The plan and Medicare cover all remaining costs.
$2,000 Out-of-Pocket Cap
The Inflation Reduction Act caps annual out-of-pocket Part D spending at $2,000 starting in 2025, with full implementation in 2026. This eliminates the catastrophic coverage phase for most enrollees and saves the average beneficiary an estimated $400 per year. Plans must also offer a monthly payment smoothing option so costs are spread evenly across the year.
Coverage by state
Part D plan availability and pricing vary by state. Select yours to see available plans, average premiums, and drug-level coverage data.
Top searched drugs on Part D
Coverage, tier placement, and prior authorization rates for the most commonly searched medications. Data updates weekly from CMS formulary files.
| Drug | Typical Tier | PA Rate | Avg Copay | Trend |
|---|---|---|---|---|
| Eliquisapixaban | Tier 3 | 8% | $47 | ▼ |
| Jardianceempagliflozin | Tier 3 | 12% | $47 | ▬ |
| Ozempicsemaglutide | Tier 5 | 42% | $285 | ▲ |
| Xareltorivaroxaban | Tier 3 | 6% | $47 | ▼ |
| Trulicitydulaglutide | Tier 3 | 15% | $47 | ▬ |
| Entrestosacubitril/valsartan | Tier 3 | 10% | $47 | ▼ |
| Atorvastatingeneric | Tier 1 | 0% | $3 | ▬ |
| Metformingeneric | Tier 1 | 0% | $2 | ▬ |
| Humiraadalimumab | Tier 5 | 68% | $310 | ▼ |
| Januviasitagliptin | Tier 3 | 18% | $47 | ▬ |
Data sourced from CMS formulary files. Actual costs depend on your specific plan. Search all drugs →