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.
ZELSUVMI (Berdazimer)
Found on the formularies of 302 of 5499 Medicare Part D plans in this dataset · Tiers 1–5 · prior authorization on 187 plans (62%) · quantity limits on 186 (62%), 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 |
|---|---|---|---|---|
| Mass General Brigham SCO (HMO D-SNP) (H0777-001) (MA) | Tier 1 | Yes | No | 31 per 30 days |
| Mass General Brigham One Care (HMO D-SNP) (H1611-001) (MA) | Tier 1 | Yes | No | 31 per 30 days |
| Platino Blindao (HMO D-SNP) (H5774-028) (PR) | Tier 1 | Yes | No | 62.00 per 84 days |
| Platino Enlace (HMO D-SNP) (H5774-035) (PR) | Tier 1 | Yes | No | 62.00 per 84 days |
| PLATINO ADVANCE (HMO D-SNP) (H5774-041) (segment 1) (PR) | Tier 1 | Yes | No | 62.00 per 84 days |
| PLATINO ADVANCE (HMO D-SNP) (H5774-041) (segment 2) (PR) | Tier 1 | Yes | No | 62.00 per 84 days |
| PLATINO ADVANCE (HMO D-SNP) (H5774-041) (segment 3) (PR) | Tier 1 | Yes | No | 62.00 per 84 days |
| PLATINO ADVANCE (HMO D-SNP) (H5774-041) (segment 4) (PR) | Tier 1 | Yes | No | 62.00 per 84 days |
| PLATINO ADVANCE (HMO D-SNP) (H5774-041) (segment 5) (PR) | Tier 1 | Yes | No | 62.00 per 84 days |
| PLATINO PLUS (HMO D-SNP) (H5774-043) (segment 1) (PR) | Tier 1 | Yes | No | 62.00 per 84 days |
| PLATINO PLUS (HMO D-SNP) (H5774-043) (segment 2) (PR) | Tier 1 | Yes | No | 62.00 per 84 days |
| PLATINO PLUS (HMO D-SNP) (H5774-043) (segment 3) (PR) | Tier 1 | Yes | No | 62.00 per 84 days |
| PLATINO PLUS (HMO D-SNP) (H5774-043) (segment 4) (PR) | Tier 1 | Yes | No | 62.00 per 84 days |
| PLATINO PLUS (HMO D-SNP) (H5774-043) (segment 5) (PR) | Tier 1 | Yes | No | 62.00 per 84 days |
| CalOptima Health OneCare Complete (HMO D-SNP) (H5433-001) (CA) | Tier 2 | Yes | No | None |
| CareAdvantage (HMO D-SNP) (H6019-001) (CA) | Tier 2 | Yes | No | 31 per 30 days |
| Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) (H0524-003) (CA) | Tier 5 | No | No | None |
| Kaiser Permanente Senior Advantage Enhanced Solano (HMO) (H0524-008) (CA) | Tier 5 | No | No | None |
| Kaiser Permanente Senior Advantage Inland Empire (HMO) (H0524-015) (CA) | Tier 5 | No | No | None |
| Kaiser Permanente Sr Adv Enhanced Marin San Mateo (HMO) (H0524-031) (CA) | Tier 5 | No | No | None |
| Kaiser Permanente Senior Advantage Ventura (HMO) (H0524-034) (CA) | Tier 5 | No | No | None |
| Kaiser Permanente Senior Advantage Enhanced Kern (HMO) (H0524-035) (CA) | Tier 5 | No | No | None |
| Kaiser Permanente Senior Advantage Basic Kern (HMO) (H0524-036) (CA) | Tier 5 | No | No | None |
| Kaiser Permanente Senior Advantage San Diego (HMO) (H0524-037) (CA) | Tier 5 | No | No | None |
| Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) (H0524-039) (CA) | Tier 5 | No | No | None |
One row per plan — showing 25 of 302 plans; a Yes means the flag applies to at least one form/strength on that plan.
Acquisition cost (NADAC): $61.88338/unit — price effective 08/19/2026
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 08/19/2026 (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=berdazimer