Drug Coverage Lookup
See how a prescription drug is placed across Medicare Part D plan formularies — tier, prior authorization, step therapy, and quantity limits, counted per unique plan.
Otezla (Apremilast)
Phosphodiesterase 4 Inhibitor
Found on the formularies of 3260 of 5499 Medicare Part D plans in this dataset · Tiers 1–5 · prior authorization on 3161 plans (97%) · quantity limits on 2977 (91%), counting a plan when at least one form/strength carries the flag.
This is dataset-wide formulary placement (data current through 2026-08-31) — check your specific plan for its current coverage and restrictions.
| Plan | Tier | Prior Auth | Step Therapy | Qty Limit |
|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) (H0034-002) (NY) | Tier 1 | Yes | No | 60 per 30 days |
| Mass General Brigham SCO (HMO D-SNP) (H0777-001) (MA) | Tier 1 | Yes | No | 60 per 30 days |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) (H1587-001) (AR) | Tier 1 | Yes | No | None |
| Mass General Brigham One Care (HMO D-SNP) (H1611-001) (MA) | Tier 1 | Yes | No | 60 per 30 days |
| Community Care's Partnership Program (HMO D-SNP) (H2034-001) (WI) | Tier 1 | Yes | No | None |
| Alameda Alliance Wellness (HMO D-SNP) (H2035-001) (CA) | Tier 1 | Yes | No | None |
| Abilis Health Community (HMO I-SNP) (H2400-002) (KY,TN) | Tier 1 | Yes | No | None |
| PrimeWest Senior Health Complete (HMO D-SNP) (H2416-001) (MN) | Tier 1 | Yes | No | None |
| SeniorCare Complete (HMO D-SNP) (H2419-001) (MN) | Tier 1 | Yes | No | None |
| SecureBlue (HMO D-SNP) (H2425-001) (MN) | Tier 1 | Yes | No | 60 per 30 days |
| Sentara Community Complete Select (HMO D-SNP) (H2563-020) (VA) | Tier 1 | Yes | No | 60 per 30 days |
| Prime Health Complete (HMO D-SNP) (H2926-001) (MN) | Tier 1 | Yes | No | None |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) (H3127-001) (MI) | Tier 1 | Yes | No | 60 per 30 days |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) (H3251-029) (NM) | Tier 1 | Yes | No | 60 per 30 days |
| PruittHealth Premier D-SNP (HMO D-SNP) (H3291-002) (GA) | Tier 1 | Yes | No | 60 per 30 days |
| AllCare Advantage Redwood Rx (HMO D-SNP) (H3810-023) (OR) | Tier 1 | Yes | No | None |
| Simpra Advantage Dual Care (PPO D-SNP) (H4091-002) (AL) | Tier 1 | Yes | No | 60 per 30 days |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) (H4093-004) (PA) | Tier 1 | Yes | No | 60 per 30 days |
| HAP CareSource MI Coordinated Health (HMO D-SNP) (H4193-001) (MI) | Tier 1 | Yes | No | 60 per 30 days |
| Provider Partners North Carolina Community Plan (HMO I-SNP) (H4439-002) (NC) | Tier 1 | Yes | No | 60 per 30 days |
| Provider Partners Indiana Community Plan (HMO I-SNP) (H4444-002) (IN) | Tier 1 | Yes | No | 60 per 30 days |
| Sentara Community Complete (HMO D-SNP) (H4499-001) (VA) | Tier 1 | Yes | No | 60 per 30 days |
| Tufts Health One Care (HMO D-SNP) (H5314-001) (MA) | Tier 1 | Yes | No | 60 per 30 days |
| Tufts Health One Care CW (HMO D-SNP) (H5314-002) (MA) | Tier 1 | Yes | No | 60 per 30 days |
| Elevate Medicare Choice (HMO D-SNP) (H5608-001) (CO) | Tier 1 | Yes | No | None |
One row per plan — showing 25 of 3260 plans; a Yes means the flag applies to at least one form/strength on that plan.
Acquisition cost (NADAC): $89.95216/unit — price effective 01/07/2026
Source: CMS Monthly Prescription Drug Plan Formulary and Pharmacy Network Information — data current through 2026-08-31 (CMS release 2026-08-26, refreshed monthly) · NADAC price effective 01/07/2026 (per-NDC last change, not a data-staleness date). Dataset-wide plan-year formulary placement, not a guarantee of your individual benefit — confirm with your plan or pharmacist.
Data: CMS Monthly Part D formulary files · FDA/RxNorm drug identity · CMS NADAC pricing — CMS Part D formulary data current through 2026-08-31 · source
GET https://insurewith.ai/tools/drug-coverage/data.json?drug=apremilast