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.
Metaxalone
Muscle Relaxant
Found on the formularies of 315 of 5499 Medicare Part D plans in this dataset · Tiers 1–5 · prior authorization on 109 plans (35%) · step therapy on 11 (3%) · quantity limits on 15 (5%), 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 | 120 per 30 days |
| SeniorCare Complete (HMO D-SNP) (H2419-001) (MN) | Tier 1 | Yes | No | 120 per 30 days |
| PruittHealth Premier D-SNP (HMO D-SNP) (H3291-002) (GA) | Tier 1 | Yes | No | None |
| Simpra Advantage Dual Care (PPO D-SNP) (H4091-002) (AL) | Tier 1 | No | No | None |
| AbilityCare (HMO D-SNP) (H5703-001) (MN) | Tier 1 | Yes | No | 120 per 30 days |
| SECUR Advantage (HMO I-SNP) (H3048-001) (FL) | Tier 1 | No | No | None |
| SECUR Enhanced (HMO I-SNP) (H3048-002) (FL) | Tier 1 | No | No | None |
| ProCare Advantage (HMO-POS I-SNP) (H3467-001) (TX) | Tier 1 | Yes | No | None |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) (H3467-002) (TX) | Tier 1 | Yes | No | None |
| American Health Advantage of Florida (HMO I-SNP) (H6652-001) (FL) | Tier 1 | No | No | None |
| Senior Care (HMO I-SNP) (H9917-001) (FL) | Tier 1 | Yes | No | None |
| Senior Care (HMO I-SNP) (H6832-001) (MI) | Tier 1 | Yes | No | None |
| AgeRight Advantage Health Plan (HMO I-SNP) (H1372-001) (OR,WA) | Tier 1 | Yes | No | None |
| Senior Care (HMO I-SNP) (H3274-001) (CA) | Tier 1 | Yes | No | None |
| Liberty Medicare Dual Plan (HMO D-SNP) (H6351-005) (NC) | Tier 1 | No | No | None |
| KeyCare Advantage (HMO I-SNP) (H6959-001) (MD) | Tier 1 | Yes | No | None |
| American Health Advantage of Mississippi (HMO I-SNP) (H9909-001) (MS) | Tier 1 | No | No | None |
| Senior Care (HMO I-SNP) (H2185-001) (VA) | Tier 1 | Yes | No | None |
| PruittHealth Premier (HMO I-SNP) (H3291-001) (GA) | Tier 1 | Yes | No | None |
| Georgia Health Advantage (HMO I-SNP) (H8093-001) (GA) | Tier 1 | No | No | None |
| Georgia Health Advantage Choice (HMO I-SNP) (H8093-002) (GA) | Tier 1 | No | No | None |
| Simpra Advantage Nursing Home Plan (PPO I-SNP) (H4091-001) (AL) | Tier 1 | No | No | None |
| American Health Advantage of Tennessee (HMO I-SNP) (H7779-001) (TN) | Tier 1 | No | No | None |
| American Health Advantage of Oklahoma (HMO I-SNP) (H3708-001) (OK) | Tier 1 | No | No | None |
| NHC Advantage (HMO I-SNP) (H4172-001) (MO,NC,SC,TN) | Tier 1 | Yes | No | None |
One row per plan — showing 25 of 315 plans; a Yes means the flag applies to at least one form/strength on that plan.
Acquisition cost (NADAC): $2.69436/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=metaxalone