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.
Keppra (Levetiracetam)
Found on the formularies of 5499 of 5499 Medicare Part D plans in this dataset · Tiers 1–5 · prior authorization on 578 plans (11%) · step therapy on 1124 (20%) · quantity limits on 3774 (69%), 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 |
| MetroPlus UltraCare (HMO D-SNP) (H0423-007) (NY) | Tier 1 | No | No | 360 per 30 days |
| AmeriHealth Caritas VIP Care (HMO D-SNP) (H0738-001) (DE) | Tiers 1–4 | No | Yes | 360 per 30 days |
| AmeriHealth Caritas VIP Care Choice (HMO D-SNP) (H0738-002) (DE) | Tiers 1–4 | No | Yes | 360 per 30 days |
| Mass General Brigham SCO (HMO D-SNP) (H0777-001) (MA) | Tier 1 | No | No | 360 per 30 days |
| Humana Dual Integrated (HMO D-SNP) (H0963-001) (MI) | Tiers 1–4 | No | Yes | 360 per 30 days |
| CareOne Plus (HMO-POS) (H1019-001) (FL) | Tiers 1–4 | No | Yes | 360 per 30 days |
| CareOne Plus (HMO) (H1019-006) (FL) | Tiers 1–4 | No | Yes | 360 per 30 days |
| CareNeeds Platinum (HMO D-SNP) (H1019-023) (FL) | Tiers 1–4 | No | Yes | 360 per 30 days |
| CareOne Plus (HMO-POS) (H1019-043) (FL) | Tiers 1–4 | No | Yes | 360 per 30 days |
| CareOne Plus (HMO-POS) (H1019-057) (FL) | Tiers 1–4 | No | Yes | 360 per 30 days |
| CareFree Giveback (HMO) (H1019-065) (FL) | Tiers 1–4 | No | Yes | 360 per 30 days |
| CareNeeds Plus (HMO D-SNP) (H1019-073) (FL) | Tiers 1–4 | No | Yes | 360 per 30 days |
| CareFree Platinum Giveback (HMO) (H1019-094) (FL) | Tiers 1–4 | No | Yes | 360 per 30 days |
| CareOne Plus (HMO) (H1019-103) (segment 1) (FL) | Tiers 1–4 | No | Yes | 360 per 30 days |
| CareOne Plus (HMO) (H1019-103) (segment 2) (FL) | Tiers 1–4 | No | Yes | 360 per 30 days |
| CareFree Platinum Giveback (HMO) (H1019-104) (segment 1) (FL) | Tiers 1–4 | No | Yes | 360 per 30 days |
| CareFree Platinum Giveback (HMO) (H1019-104) (segment 2) (FL) | Tiers 1–4 | No | Yes | 360 per 30 days |
| CareComplete Platinum (HMO C-SNP) (H1019-109) (FL) | Tiers 1–4 | No | Yes | 360 per 30 days |
| CareOne Plus (HMO) (H1019-113) (FL) | Tiers 1–4 | No | Yes | 360 per 30 days |
| CareBreeze Platinum (HMO C-SNP) (H1019-118) (FL) | Tiers 1–4 | No | Yes | 360 per 30 days |
| CareComplete Platinum (HMO C-SNP) (H1019-121) (FL) | Tiers 1–4 | No | Yes | 360 per 30 days |
| CareBreeze Platinum (HMO C-SNP) (H1019-123) (FL) | Tiers 1–4 | No | Yes | 360 per 30 days |
| CareBreeze Platinum (HMO-POS C-SNP) (H1019-124) (FL) | Tiers 1–4 | No | Yes | 360 per 30 days |
| CareComplete Platinum (HMO-POS C-SNP) (H1019-130) (FL) | Tiers 1–4 | No | Yes | 360 per 30 days |
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): $0.02993/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=levetiracetam