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.
Rayaldee (Calcifediol)
Found on the formularies of 1590 of 5499 Medicare Part D plans in this dataset · Tiers 1–5 · prior authorization on 1 plans (0%) · quantity limits on 1034 (65%), 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 | No | No | None |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) (H1587-001) (AR) | Tier 1 | No | No | 60 per 30 days |
| Mass General Brigham One Care (HMO D-SNP) (H1611-001) (MA) | Tier 1 | No | No | None |
| Abilis Health Community (HMO I-SNP) (H2400-002) (KY,TN) | Tier 1 | No | No | 60 per 30 days |
| PrimeWest Senior Health Complete (HMO D-SNP) (H2416-001) (MN) | Tier 1 | No | No | 60 per 30 days |
| Prime Health Complete (HMO D-SNP) (H2926-001) (MN) | Tier 1 | No | No | 60 per 30 days |
| AllCare Advantage Redwood Rx (HMO D-SNP) (H3810-023) (OR) | Tier 1 | No | No | 60 per 30 days |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) (H4093-004) (PA) | 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 |
| 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 |
| Elevate Medicare Choice (HMO D-SNP) (H5608-001) (CO) | Tier 1 | No | No | 60 per 30 days |
| Provider Partners Maryland Community Plan (HMO I-SNP) (H8067-003) (MD) | Tier 1 | No | No | None |
| Tufts Health Plan Senior Care Options (HMO D-SNP) (H8330-001) (MA) | Tier 1 | No | No | None |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) (H8330-002) (MA) | Tier 1 | No | No | None |
| Nascentia Dual Advantage (HMO D-SNP) (H9066-003) (NY) | Tier 1 | No | No | 60 per 30 days |
| Provider Partners Missouri Community Plan (HMO I-SNP) (H9191-004) (MO) | Tier 1 | No | No | None |
| Alterwood Advantage Dual Secure (HMO D-SNP) (H9306-004) (MD) | Tier 1 | No | No | 60 per 30 days |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) (H1526-004) (FL) | Tier 1 | No | No | 60 per 30 days |
| Provider Partners Texas Advantage Plan (HMO I-SNP) (H4054-001) (TX) | Tier 1 | No | No | None |
| Texas Independence Health Plan, Inc. (HMO I-SNP) (H5015-001) (TX) | Tier 1 | No | No | 60 per 30 days |
| Texas Independence Community Plan (HMO I-SNP) (H5015-002) (TX) | Tier 1 | No | No | 60 per 30 days |
| Tribute Select (HMO-POS I-SNP) (H1587-003) (AR) | Tier 1 | No | No | 60 per 30 days |
| ATRIO Special Needs Plan (HMO D-SNP) (H3814-007) (OR) | Tier 1 | No | No | 60 per 30 days |
One row per plan — showing 25 of 1590 plans; a Yes means the flag applies to at least one form/strength on that plan.
Acquisition cost (NADAC): $41.28448/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=calcifediol