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.

Cambia (Diclofenac)

Nonsteroidal Anti-inflammatory Drug

On Part D plan formularies — with restrictions

Found on the formularies of 5499 of 5499 Medicare Part D plans in this dataset · Tiers 1–5 · prior authorization on 3351 plans (61%) · step therapy on 112 (2%) · quantity limits on 5281 (96%), 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.

Found on the formularies of 5499 of 5499 Medicare Part D plans in this dataset, but prior authorization appears on 3351 of those 5499 plans (for at least one form/strength); step therapy on 112. Check your specific plan for its current rules, and learn what your prescriber needs to submit.

How prior authorization works →

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
MetroPlus UltraCare (HMO D-SNP) (H0423-007) (NY)	Tier 1	No	No	300 per 28 days
Blue Shield 65 Plus (HMO) (H0504-015) (CA)	Tiers 1–4	Yes	No	100 per 30 days
Blue Shield 65 Plus (HMO) (H0504-017) (CA)	Tiers 1–4	Yes	No	100 per 30 days
Blue Shield 65 Plus Plan 2 (HMO) (H0504-021) (CA)	Tiers 1–4	Yes	No	100 per 30 days
Blue Shield 65 Plus (HMO) (H0504-026) (CA)	Tiers 1–4	Yes	No	100 per 30 days
Blue Shield 65 Plus (HMO) (H0504-028) (CA)	Tiers 1–4	Yes	No	100 per 30 days
Blue Shield 65 Plus (HMO) (H0504-038) (CA)	Tiers 1–4	Yes	No	100 per 30 days
Blue Shield 65 Plus (HMO) (H0504-039) (CA)	Tiers 1–4	Yes	No	100 per 30 days
Blue Shield 65 Plus Choice Plan (HMO) (H0504-040) (CA)	Tiers 1–4	Yes	No	100 per 30 days
Blue Shield Inspire (HMO) (H0504-043) (CA)	Tiers 1–4	Yes	No	100 per 30 days
Blue Shield Inspire (HMO) (H0504-047) (CA)	Tiers 1–4	Yes	No	100 per 30 days
Anthem Medicare Advantage (HMO-POS) (H0544-056) (CA)	Tiers 1–4	Yes	No	300 per 30 days
Anthem Select (HMO-POS) (H0544-058) (CA)	Tiers 1–4	Yes	No	300 per 30 days
Anthem Medicare Advantage (HMO-POS) (H0544-061) (CA)	Tiers 1–4	Yes	No	300 per 30 days
Anthem Medicare Advantage (HMO-POS) (H0544-062) (CA)	Tiers 1–4	Yes	No	300 per 30 days
Anthem Medicare Advantage (HMO-POS) (H0544-063) (CA)	Tiers 1–4	Yes	No	300 per 30 days
Anthem Medicare Advantage (HMO-POS) (H0544-064) (CA)	Tiers 1–4	Yes	No	300 per 30 days
Anthem Medicare Advantage (HMO-POS) (H0544-065) (CA)	Tiers 1–4	Yes	No	300 per 30 days
Anthem Select (HMO-POS) (H0544-066) (CA)	Tiers 1–4	Yes	No	300 per 30 days
Anthem Select (HMO-POS) (H0544-069) (CA)	Tiers 1–4	Yes	No	300 per 30 days
Anthem Select (HMO-POS) (H0544-091) (CA)	Tiers 1–4	Yes	No	300 per 30 days
Anthem Medicare Advantage (HMO-POS) (H0544-095) (CA)	Tiers 1–4	Yes	No	300 per 30 days
Anthem Medicare Advantage (HMO-POS) (H0544-096) (CA)	Tiers 1–4	Yes	No	300 per 30 days
Anthem Select (HMO-POS) (H0544-098) (CA)	Tiers 1–4	Yes	No	300 per 30 days

One row per plan — showing 25 of 5499 plans; a Yes means the flag applies to at least one form/strength on that plan.

Acquisition cost (NADAC): $1.70634/unit — price effective 08/19/2026

For benefits professionals

Plan sponsors and advisors: formulary-placement and utilization analysis across plans.

For benefits teams: plan formulary analysis →

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

Machine access — this tool is available as structured data for AI assistants and agents:
GET https://insurewith.ai/tools/drug-coverage/data.json?drug=diclofenac