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.
FLECTOR (Diclofenac Epolamine)
Found on the formularies of 295 of 5499 Medicare Part D plans in this dataset · Tiers 1–4 · prior authorization on 227 plans (77%) · quantity limits on 236 (80%), 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 | 60 per 30 days |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) (H1587-001) (AR) | Tier 1 | Yes | No | 60 per 30 days |
| 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 | No | No | None |
| Abilis Health Community (HMO I-SNP) (H2400-002) (KY,TN) | Tier 1 | Yes | No | 60 per 30 days |
| PrimeWest Senior Health Complete (HMO D-SNP) (H2416-001) (MN) | Tier 1 | Yes | No | 60 per 30 days |
| SeniorCare Complete (HMO D-SNP) (H2419-001) (MN) | Tier 1 | No | No | None |
| Prime Health Complete (HMO D-SNP) (H2926-001) (MN) | Tier 1 | Yes | No | 60 per 30 days |
| AllCare Advantage Redwood Rx (HMO D-SNP) (H3810-023) (OR) | Tier 1 | Yes | No | 60 per 30 days |
| CalOptima Health OneCare Complete (HMO D-SNP) (H5433-001) (CA) | Tier 1 | Yes | No | 60 per 30 days |
| Elevate Medicare Choice (HMO D-SNP) (H5608-001) (CO) | Tier 1 | Yes | No | 60 per 30 days |
| AbilityCare (HMO D-SNP) (H5703-001) (MN) | Tier 1 | No | No | None |
| Platino Blindao (HMO D-SNP) (H5774-028) (PR) | Tier 1 | No | No | 60.00 per 30 days |
| Platino Enlace (HMO D-SNP) (H5774-035) (PR) | Tier 1 | No | No | 60.00 per 30 days |
| PLATINO ADVANCE (HMO D-SNP) (H5774-041) (segment 1) (PR) | Tier 1 | No | No | 60.00 per 30 days |
| PLATINO ADVANCE (HMO D-SNP) (H5774-041) (segment 2) (PR) | Tier 1 | No | No | 60.00 per 30 days |
| PLATINO ADVANCE (HMO D-SNP) (H5774-041) (segment 3) (PR) | Tier 1 | No | No | 60.00 per 30 days |
| PLATINO ADVANCE (HMO D-SNP) (H5774-041) (segment 4) (PR) | Tier 1 | No | No | 60.00 per 30 days |
| PLATINO ADVANCE (HMO D-SNP) (H5774-041) (segment 5) (PR) | Tier 1 | No | No | 60.00 per 30 days |
| PLATINO PLUS (HMO D-SNP) (H5774-043) (segment 1) (PR) | Tier 1 | No | No | 60.00 per 30 days |
| PLATINO PLUS (HMO D-SNP) (H5774-043) (segment 2) (PR) | Tier 1 | No | No | 60.00 per 30 days |
| PLATINO PLUS (HMO D-SNP) (H5774-043) (segment 3) (PR) | Tier 1 | No | No | 60.00 per 30 days |
| PLATINO PLUS (HMO D-SNP) (H5774-043) (segment 4) (PR) | Tier 1 | No | No | 60.00 per 30 days |
| PLATINO PLUS (HMO D-SNP) (H5774-043) (segment 5) (PR) | Tier 1 | No | No | 60.00 per 30 days |
One row per plan — showing 25 of 295 plans; a Yes means the flag applies to at least one form/strength on that plan.
Acquisition cost (NADAC): $4.81004/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=diclofenac-epolamine