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.
Besivance (Besifloxacin)
Quinolone Antimicrobial
Found on the formularies of 3035 of 5499 Medicare Part D plans in this dataset · Tiers 1–4 · prior authorization on 1 plans (0%) · quantity limits on 16 (1%), 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 | No | No | None |
| MetroPlus UltraCare (HMO D-SNP) (H0423-007) (NY) | Tier 1 | No | No | None |
| Mass General Brigham SCO (HMO D-SNP) (H0777-001) (MA) | Tier 1 | No | No | None |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) (H1225-003) (MD) | Tier 1 | No | No | None |
| CCA One Care (HMO D-SNP) (H1486-001) (MA) | Tier 1 | No | No | None |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) (H1587-001) (AR) | Tier 1 | No | No | None |
| Mass General Brigham One Care (HMO D-SNP) (H1611-001) (MA) | Tier 1 | No | No | None |
| Senior Whole Health SCO (HMO D-SNP) (H2224-001) (MA) | Tier 1 | No | No | None |
| Senior Whole Health SCO NHC (HMO D-SNP) (H2224-003) (MA) | Tier 1 | No | No | None |
| CCA Senior Care Options (HMO D-SNP) (H2225-001) (MA) | Tier 1 | No | No | None |
| Abilis Health Community (HMO I-SNP) (H2400-002) (KY,TN) | Tier 1 | No | No | None |
| IMCare Classic (HMO D-SNP) (H2417-001) (MN) | Tier 1 | No | No | None |
| SecureBlue (HMO D-SNP) (H2425-001) (MN) | Tier 1 | No | No | None |
| Sentara Community Complete Select (HMO D-SNP) (H2563-020) (VA) | Tier 1 | No | No | None |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) (H3251-029) (NM) | Tier 1 | No | No | None |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) (H3347-007) (NY) | Tier 1 | No | No | None |
| Healthfirst CompleteCare (HMO D-SNP) (H3359-034) (NY) | Tier 1 | No | No | None |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) (H4093-004) (PA) | Tier 1 | No | No | None |
| Molina One Care (HMO D-SNP) (H4371-001) (MA) | Tier 1 | No | No | None |
| Provider Partners North Carolina Community Plan (HMO I-SNP) (H4439-002) (NC) | Tier 1 | No | No | None |
| Provider Partners Indiana Community Plan (HMO I-SNP) (H4444-002) (IN) | Tier 1 | No | No | None |
| Sentara Community Complete (HMO D-SNP) (H4499-001) (VA) | Tier 1 | No | No | None |
| Tufts Health One Care (HMO D-SNP) (H5314-001) (MA) | Tier 1 | No | No | None |
| Tufts Health One Care CW (HMO D-SNP) (H5314-002) (MA) | Tier 1 | No | No | None |
| CalOptima Health OneCare Complete (HMO D-SNP) (H5433-001) (CA) | Tier 1 | Yes | No | 5 per 30 days |
One row per plan — showing 25 of 3035 plans; a Yes means the flag applies to at least one form/strength on that plan.
Acquisition cost (NADAC): $44.12449/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=besifloxacin