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.
Orilissa (Elagolix)
Found on the formularies of 339 of 5499 Medicare Part D plans in this dataset · Tiers 1–5 · prior authorization on 216 plans (64%) · quantity limits on 199 (59%), 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 |
|---|---|---|---|---|
| Alameda Alliance Wellness (HMO D-SNP) (H2035-001) (CA) | Tier 1 | Yes | No | None |
| Abilis Health Community (HMO I-SNP) (H2400-002) (KY,TN) | Tier 1 | Yes | No | 56 per 28 days |
| PrimeWest Senior Health Complete (HMO D-SNP) (H2416-001) (MN) | Tier 1 | Yes | No | 56 per 28 days |
| SeniorCare Complete (HMO D-SNP) (H2419-001) (MN) | Tier 1 | Yes | No | None |
| Prime Health Complete (HMO D-SNP) (H2926-001) (MN) | Tier 1 | Yes | No | 56 per 28 days |
| AllCare Advantage Redwood Rx (HMO D-SNP) (H3810-023) (OR) | Tier 1 | Yes | No | 56 per 28 days |
| Elevate Medicare Choice (HMO D-SNP) (H5608-001) (CO) | Tier 1 | Yes | No | 56 per 28 days |
| AbilityCare (HMO D-SNP) (H5703-001) (MN) | Tier 1 | Yes | No | None |
| Nascentia Dual Advantage (HMO D-SNP) (H9066-003) (NY) | Tier 1 | Yes | No | 56 per 28 days |
| Alterwood Advantage Dual Secure (HMO D-SNP) (H9306-004) (MD) | Tier 1 | Yes | No | 56 per 28 days |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) (H1526-004) (FL) | Tier 1 | Yes | No | 56 per 28 days |
| Texas Independence Health Plan, Inc. (HMO I-SNP) (H5015-001) (TX) | Tier 1 | Yes | No | 56 per 28 days |
| Texas Independence Community Plan (HMO I-SNP) (H5015-002) (TX) | Tier 1 | Yes | No | 56 per 28 days |
| ATRIO Special Needs Plan (HMO D-SNP) (H3814-007) (OR) | Tier 1 | Yes | No | 56 per 28 days |
| ATRIO Special Needs Plan (HMO D-SNP) (H3814-030) (OR) | Tier 1 | Yes | No | 56 per 28 days |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) (H4869-014) (AZ) | Tier 1 | Yes | No | 56 per 28 days |
| CommuniCare Advantage ISNP (HMO I-SNP) (H3727-002) (segment 2) (MD) | Tier 1 | Yes | No | 56 per 28 days |
| Alterwood Advantage Dual Value (HMO D-SNP) (H9306-007) (MD) | Tier 1 | Yes | No | 56 per 28 days |
| Valor Health Plan (HMO I-SNP) (H1119-001) (OH) | Tier 1 | Yes | No | 56 per 28 days |
| CommuniCare Advantage ISNP (HMO I-SNP) (H3727-002) (segment 3) (OH) | Tier 1 | Yes | No | 56 per 28 days |
| WV Senior Advantage (HMO I-SNP) (H9153-001) (WV) | Tier 1 | Yes | No | 56 per 28 days |
| Abilis Health (HMO I-SNP) (H2400-001) (KY,TN) | Tier 1 | Yes | No | 56 per 28 days |
| CommuniCare Advantage ISNP (HMO I-SNP) (H3727-002) (segment 1) (IN) | Tier 1 | Yes | No | 56 per 28 days |
| Nascentia Skilled Nursing Facility (HMO I-SNP) (H9066-002) (NY) | Tier 1 | Yes | No | 56 per 28 days |
| FHCP Medicare Classic (HMO) (H1035-040) (FL) | Tier 3 | Yes | No | None |
One row per plan — showing 25 of 339 plans; a Yes means the flag applies to at least one form/strength on that plan.
Acquisition cost (NADAC): $43.81958/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=elagolix