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.
Acticlate (Doxycycline Hyclate)
Tetracycline-class Drug
Found on the formularies of 5499 of 5499 Medicare Part D plans in this dataset · Tiers 1–6 · prior authorization on 433 plans (8%) · quantity limits on 15 (0%), 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 |
| HealthSpring Preferred (HMO) (H0354-001) (AZ) | Tiers 1–4 | Yes | No | None |
| HealthSpring Achieve (HMO C-SNP) (H0354-027) (AZ) | Tiers 1–4 | Yes | No | None |
| HealthSpring Alliance (HMO) (H0354-028) (AZ) | Tiers 1–4 | Yes | No | None |
| HealthSpring Preferred Savings (HMO) (H0354-029) (AZ) | Tiers 1–4 | Yes | No | None |
| HealthSpring Preferred Full Savings (HMO) (H0354-030) (AZ) | Tiers 1–4 | Yes | No | None |
| MetroPlus UltraCare (HMO D-SNP) (H0423-007) (NY) | Tier 1 | No | No | None |
| HealthSpring Preferred GA (HMO) (H0439-003) (segment 1) (GA) | Tiers 1–4 | Yes | No | None |
| HealthSpring Preferred (HMO) (H0439-008) (GA) | Tiers 1–4 | Yes | No | None |
| HealthSpring Preferred (HMO) (H0439-009) (GA) | Tiers 1–4 | Yes | No | None |
| HealthSpring Preferred (HMO) (H0439-010) (GA) | Tiers 1–4 | Yes | No | None |
| HealthSpring Preferred (HMO) (H0439-011) (GA) | Tiers 1–4 | Yes | No | None |
| HealthSpring TotalCare Plus (HMO D-SNP) (H0439-012) (GA) | Tiers 1–4 | Yes | No | None |
| HealthSpring Preferred (HMO) (H0439-013) (GA) | Tiers 1–4 | Yes | No | None |
| HealthSpring Preferred (HMO) (H0439-015) (segment 1) (GA) | Tiers 1–4 | Yes | No | None |
| HealthSpring Preferred (HMO) (H0439-015) (segment 2) (GA) | Tiers 1–4 | Yes | No | None |
| HealthSpring Preferred Savings (HMO) (H0439-016) (GA) | Tiers 1–4 | Yes | No | None |
| HealthSpring Preferred Savings (HMO) (H0439-017) (GA) | Tiers 1–4 | Yes | No | None |
| HealthSpring Preferred Savings (HMO) (H0439-018) (GA) | Tiers 1–4 | Yes | No | None |
| HealthSpring Preferred Savings (HMO) (H0439-019) (GA) | Tiers 1–4 | Yes | No | None |
| HealthSpring Preferred (HMO) (H0439-020) (MO) | Tiers 1–4 | Yes | No | None |
| HealthSpring Preferred Savings (HMO) (H0439-021) (MO) | Tiers 1–4 | Yes | No | None |
| HealthSpring TotalCare Plus (HMO D-SNP) (H0439-023) (MO) | Tiers 1–4 | Yes | No | None |
| HealthSpring Premier (HMO-POS) (H0439-024) (UT) | Tiers 1–4 | Yes | No | None |
| Anthem Select (HMO-POS) (H0544-058) (CA) | Tiers 1–4 | No | No | None |
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): $0.10794/unit — price effective 10/21/2026
Source: CMS Monthly Prescription Drug Plan Formulary and Pharmacy Network Information — data current through 2026-08-31 (CMS release 2026-08-26, refreshed monthly) · a newer CMS release may be available — this dataset is more than 2 months old · NADAC price effective 10/21/2026 (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=doxycycline-hyclate