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.
ORKAMBI (Lumacaftor and Ivacaftor)
Cystic Fibrosis Transmembrane Conductance Regulator Potentiator
Found on the formularies of 4233 of 5499 Medicare Part D plans in this dataset · Tiers 1–6 · prior authorization on 4133 plans (98%) · quantity limits on 3979 (94%), 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 | Yes | No | 60 per 30 days |
| MetroPlus UltraCare (HMO D-SNP) (H0423-007) (NY) | Tier 1 | Yes | No | 56 per 28 days |
| Mass General Brigham SCO (HMO D-SNP) (H0777-001) (MA) | Tier 1 | Yes | No | 56 per 28 days |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) (H1225-003) (MD) | Tier 1 | Yes | No | 56 per 28 days |
| CCA One Care (HMO D-SNP) (H1486-001) (MA) | Tier 1 | Yes | No | 56 per 28 days |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) (H1587-001) (AR) | Tier 1 | Yes | No | 112 per 28 days |
| Mass General Brigham One Care (HMO D-SNP) (H1611-001) (MA) | Tier 1 | Yes | No | 56 per 28 days |
| Community Care's Partnership Program (HMO D-SNP) (H2034-001) (WI) | Tier 1 | No | No | None |
| Alameda Alliance Wellness (HMO D-SNP) (H2035-001) (CA) | Tier 1 | Yes | No | None |
| Senior Whole Health SCO (HMO D-SNP) (H2224-001) (MA) | Tier 1 | Yes | No | 56 per 28 days |
| Senior Whole Health SCO NHC (HMO D-SNP) (H2224-003) (MA) | Tier 1 | Yes | No | 56 per 28 days |
| CCA Senior Care Options (HMO D-SNP) (H2225-001) (MA) | Tier 1 | Yes | No | 56 per 28 days |
| Abilis Health Community (HMO I-SNP) (H2400-002) (KY,TN) | Tier 1 | Yes | No | 112 per 28 days |
| PrimeWest Senior Health Complete (HMO D-SNP) (H2416-001) (MN) | Tier 1 | Yes | No | 112 per 28 days |
| IMCare Classic (HMO D-SNP) (H2417-001) (MN) | Tier 1 | Yes | No | 56 per 28 days |
| SeniorCare Complete (HMO D-SNP) (H2419-001) (MN) | Tier 1 | Yes | No | None |
| SecureBlue (HMO D-SNP) (H2425-001) (MN) | Tier 1 | Yes | No | 60 per 30 days |
| Sentara Community Complete Select (HMO D-SNP) (H2563-020) (VA) | Tier 1 | Yes | No | 56 per 28 days |
| Prime Health Complete (HMO D-SNP) (H2926-001) (MN) | Tier 1 | Yes | No | 112 per 28 days |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) (H3127-001) (MI) | Tier 1 | Yes | No | 56 per 28 days |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) (H3251-029) (NM) | Tier 1 | Yes | No | 60 per 30 days |
| PruittHealth Premier D-SNP (HMO D-SNP) (H3291-002) (GA) | Tier 1 | Yes | No | 56 per 28 days |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) (H3347-007) (NY) | Tier 1 | Yes | No | 56 per 28 days |
| Healthfirst CompleteCare (HMO D-SNP) (H3359-034) (NY) | Tier 1 | Yes | No | 56 per 28 days |
| AllCare Advantage Redwood Rx (HMO D-SNP) (H3810-023) (OR) | Tier 1 | Yes | No | 112 per 28 days |
One row per plan — showing 25 of 4233 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=lumacaftor-and-ivacaftor