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.
FORZINITY (Elamipretide)
Found on the formularies of 52 of 5499 Medicare Part D plans in this dataset · Tiers 1–5 · prior authorization on 52 plans (100%) · quantity limits on 42 (81%), 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 |
|---|---|---|---|---|
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) (H5932-001) (PA) | Tier 1 | Yes | No | 14 per 28 days |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) (H5932-012) (PA) | Tier 1 | Yes | No | 14 per 28 days |
| Highmark Health Options Duals (HMO D-SNP) (H6224-001) (WV) | Tier 1 | Yes | No | 14 per 28 days |
| Highmark Health Options Duals (HMO D-SNP) (H7710-001) (DE) | Tier 1 | Yes | No | 14 per 28 days |
| NaviCare (HMO D-SNP) (H8928-001) (MA) | Tier 1 | Yes | No | 14 per 28 days |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) (H5932-013) (PA) | Tier 1 | Yes | No | 14 per 28 days |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) (H5932-009) (PA) | Tier 1 | Yes | No | 14 per 28 days |
| Highmark Health Options Duals Select (HMO D-SNP) (H7710-002) (DE) | Tier 1 | Yes | No | 14 per 28 days |
| CalOptima Health OneCare Complete (HMO D-SNP) (H5433-001) (CA) | Tier 2 | Yes | No | 14 per 28 days |
| Health First Rewards H1099-014 (HMO) (FL) | Tier 5 | Yes | No | None |
| Health First SunSaver H1099-016 (HMO) (FL) | Tier 5 | Yes | No | None |
| Health First Complete Care H1099-023 (HMO) (FL) | Tier 5 | Yes | No | None |
| Health First Emerald Plus H1099-024 (HMO) (FL) | Tier 5 | Yes | No | None |
| Health First Premier Access H1099-025 (HMO-POS) (FL) | Tier 5 | Yes | No | None |
| Health First Emerald Plus H1099-026 (HMO) (FL) | Tier 5 | Yes | No | None |
| Health First Premier Access H1099-027 (HMO-POS) (FL) | Tier 5 | Yes | No | None |
| Health First Emerald Plus H1099-028 (HMO) (FL) | Tier 5 | Yes | No | None |
| Prominence Plus (HMO) (H5945-001) (NV) | Tier 5 | Yes | No | 4 per 28 days |
| Prominence Plus (HMO) (H5945-002) (NV) | Tier 5 | Yes | No | 4 per 28 days |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) (H5945-016) (NV) | Tier 5 | Yes | No | 4 per 28 days |
| Prominence Dual (HMO D-SNP) (H5945-017) (NV) | Tier 5 | Yes | No | 4 per 28 days |
| Prominence Dual (HMO D-SNP) (H5945-018) (NV) | Tier 5 | Yes | No | 4 per 28 days |
| Prominence Giveback (HMO) (H5945-027) (NV) | Tier 5 | Yes | No | 4 per 28 days |
| Prominence Plus (HMO) (H7239-001) (FL) | Tier 5 | Yes | No | 4 per 28 days |
| Prominence Dual (HMO D-SNP) (H7239-002) (FL) | Tier 5 | Yes | No | 4 per 28 days |
One row per plan — showing 25 of 52 plans; a Yes means the flag applies to at least one form/strength on that plan.
Source: CMS Monthly Prescription Drug Plan Formulary and Pharmacy Network Information — data current through 2026-08-31 (CMS release 2026-08-26, refreshed monthly). 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=elamipretide