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.
FABHALTA (Iptacopan)
Found on the formularies of 299 of 5499 Medicare Part D plans in this dataset · Tiers 1–5 · prior authorization on 200 plans (67%) · quantity limits on 175 (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 |
|---|---|---|---|---|
| Mass General Brigham SCO (HMO D-SNP) (H0777-001) (MA) | Tier 1 | Yes | No | 60 per 30 days |
| Mass General Brigham One Care (HMO D-SNP) (H1611-001) (MA) | Tier 1 | Yes | No | 60 per 30 days |
| Alameda Alliance Wellness (HMO D-SNP) (H2035-001) (CA) | Tier 1 | Yes | No | None |
| SeniorCare Complete (HMO D-SNP) (H2419-001) (MN) | Tier 1 | Yes | No | None |
| AbilityCare (HMO D-SNP) (H5703-001) (MN) | Tier 1 | Yes | No | None |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) (H5932-001) (PA) | Tier 1 | Yes | No | 60 per 30 days |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) (H5932-012) (PA) | Tier 1 | Yes | No | 60 per 30 days |
| Highmark Health Options Duals (HMO D-SNP) (H6224-001) (WV) | Tier 1 | Yes | No | 60 per 30 days |
| Highmark Health Options Duals (HMO D-SNP) (H7710-001) (DE) | Tier 1 | Yes | No | 60 per 30 days |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) (H5932-013) (PA) | Tier 1 | Yes | No | 60 per 30 days |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) (H5932-009) (PA) | Tier 1 | Yes | No | 60 per 30 days |
| Highmark Health Options Duals Select (HMO D-SNP) (H7710-002) (DE) | Tier 1 | Yes | No | 60 per 30 days |
| CalOptima Health OneCare Complete (HMO D-SNP) (H5433-001) (CA) | Tier 2 | Yes | No | 60 per 30 days |
| Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) (H0524-003) (CA) | Tier 5 | No | No | None |
| Kaiser Permanente Senior Advantage Enhanced Solano (HMO) (H0524-008) (CA) | Tier 5 | No | No | None |
| Kaiser Permanente Senior Advantage Inland Empire (HMO) (H0524-015) (CA) | Tier 5 | No | No | None |
| Kaiser Permanente Sr Adv Enhanced Marin San Mateo (HMO) (H0524-031) (CA) | Tier 5 | No | No | None |
| Kaiser Permanente Senior Advantage Ventura (HMO) (H0524-034) (CA) | Tier 5 | No | No | None |
| Kaiser Permanente Senior Advantage Enhanced Kern (HMO) (H0524-035) (CA) | Tier 5 | No | No | None |
| Kaiser Permanente Senior Advantage Basic Kern (HMO) (H0524-036) (CA) | Tier 5 | No | No | None |
| Kaiser Permanente Senior Advantage San Diego (HMO) (H0524-037) (CA) | Tier 5 | No | No | None |
| Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) (H0524-039) (CA) | Tier 5 | No | No | None |
| Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) (H0524-040) (CA) | Tier 5 | No | No | None |
| Kaiser Permanente Senior Advantage Basic Stanis (HMO) (H0524-041) (CA) | Tier 5 | No | No | None |
| Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) (H0524-043) (CA) | Tier 5 | No | No | None |
One row per plan — showing 25 of 299 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=iptacopan