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.
Aricept (Donepezil)
Cholinesterase Inhibitor
Found on the formularies of 5499 of 5499 Medicare Part D plans in this dataset · Tiers 1–6 · step therapy on 17 (0%) · quantity limits on 4607 (84%), 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 |
|---|---|---|---|---|
| Humana Gold Plus H0028-014 (HMO) (IL,MO) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus H0028-019 (HMO) (NM) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus H0028-021 (HMO) (AZ) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus H0028-024 (HMO) (AZ) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus H0028-028 (HMO) (AZ) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus H0028-029 (HMO) (TX) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus H0028-030 (HMO) (TX) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) (TX) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus H0028-035 (HMO) (TX) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus SNP-DE H0028-036 (HMO D-SNP) (TX) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus H0028-037 (HMO) (TX) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) (H0028-039) (TX) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus H0028-041 (HMO) (TX) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus H0028-042 (HMO) (TX) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus H0028-043 (HMO) (segment 1) (TX) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus H0028-043 (HMO) (segment 2) (TX) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus H0028-046 (HMO) (TX) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) (H0028-051) (MO) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus H0028-053 (HMO) (segment 1) (IA) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus H0028-053 (HMO) (segment 3) (NE) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus H0028-054 (HMO-POS) (segment 1) (KS,MO) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus H0028-054 (HMO-POS) (segment 2) (KS) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) (H0028-055) (MO) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP) (H0028-056) (KS) | Tiers 1–3 | No | No | 30 per 30 days |
| Humana Gold Plus H0028-059 (HMO) (TX) | Tiers 1–3 | No | No | 30 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): $0.04761/unit — price effective 05/20/2026
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 05/20/2026 (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=donepezil