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.
BONJESTA (Doxylamine and Pyridoxine)
Antihistamine
Found on the formularies of 14 of 5499 Medicare Part D plans in this dataset · Tiers 2–4 · prior authorization on 12 plans (86%) · quantity limits on 12 (86%), 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 |
|---|---|---|---|---|
| FHCP Medicare Classic (HMO) (H1035-040) (FL) | Tier 2 | No | No | None |
| FHCP Medicare Rx Plus (HMO-POS) (H1035-002) (FL) | Tier 2 | No | No | None |
| Geisinger Gold Preferred Complete Rx (PPO) (H3924-065) (PA) | Tier 4 | Yes | No | 120 per 30 days |
| Geisinger Gold Secure Rx (HMO D-SNP) (H3954-097) (PA) | Tier 4 | Yes | No | 120 per 30 days |
| Geisinger Gold Classic 360 Rx (HMO) (H3954-160) (PA) | Tier 4 | Yes | No | 120 per 30 days |
| Geisinger Gold Classic Essential Rx (HMO) (H3954-161) (PA) | Tier 4 | Yes | No | 120 per 30 days |
| Geisinger Gold Value Rx (HMO) (H3954-163) (PA) | Tier 4 | Yes | No | 120 per 30 days |
| Geisinger Gold Classic Complete Rx (HMO) (H3954-158) (segment 13) (PA) | Tier 4 | Yes | No | 120 per 30 days |
| Geisinger Gold Classic Complete Rx (HMO) (H3954-158) (segment 14) (PA) | Tier 4 | Yes | No | 120 per 30 days |
| Geisinger Gold Preferred Advantage Rx (PPO) (H3924-059) (segment 22) (PA) | Tier 4 | Yes | No | 120 per 30 days |
| Geisinger Gold Classic Advantage Rx (HMO) (H3954-157) (segment 21) (PA) | Tier 4 | Yes | No | 120 per 30 days |
| Geisinger Gold Classic Advantage Rx (HMO) (H3954-157) (segment 22) (PA) | Tier 4 | Yes | No | 120 per 30 days |
| Geisinger Gold Classic Advantage Rx (HMO) (H3954-157) (segment 23) (PA) | Tier 4 | Yes | No | 120 per 30 days |
| Geisinger Gold Preferred Advantage Rx (PPO) (H3924-059) (segment 21) (PA) | Tier 4 | Yes | No | 120 per 30 days |
One row per plan; a Yes means the flag applies to at least one form/strength on that plan.
Acquisition cost (NADAC): $1.14547/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=doxylamine-and-pyridoxine