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.
METRONIDAZOLE (Metronidazole Topical)
Nitroimidazole Antimicrobial
Found on the formularies of 5499 of 5499 Medicare Part D plans in this dataset · Tiers 1–6 · prior authorization on 436 plans (8%) · quantity limits on 1765 (32%), 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.
Matched on the active ingredient "metronidazole" across every strength and form listed in this dataset (the identity layer resolved "metronidazole-topical" to "Metronidazole Topical", which is one product rather than the ingredient).
| Plan | Tier | Prior Auth | Step Therapy | Qty Limit |
|---|---|---|---|---|
| Wellcare Giveback (HMO-POS) (H0029-009) (WA) | Tiers 1–4 | No | No | 59 per 30 days |
| Wellcare Simple (HMO-POS) (H0029-011) (WA) | Tiers 1–4 | No | No | 59 per 30 days |
| Hamaspik Medicare Choice (HMO D-SNP) (H0034-002) (NY) | Tier 1 | No | No | None |
| Wellcare Simple Open (PPO) (H0074-001) (MS) | Tiers 1–4 | No | No | 59 per 30 days |
| Wellcare Simple Open (PPO) (H0111-001) (GA) | Tiers 1–4 | No | No | 59 per 30 days |
| VIVA Medicare Plus (HMO) (H0154-015) (segment 1) (AL) | Tiers 1–4 | No | No | 59 per 30 days |
| VIVA Medicare Plus (HMO) (H0154-015) (segment 2) (AL) | Tiers 1–4 | No | No | 59 per 30 days |
| VIVA Medicare Classic (HMO) (H0154-017) (AL) | Tiers 1–4 | No | No | 59 per 30 days |
| VIVA Medicare Infirmary Health Advantage (HMO) (H0154-020) (AL) | Tiers 1–4 | No | No | 59 per 30 days |
| Wellcare Simple (HMO) (H0174-010) (TX) | Tiers 1–4 | No | No | 59 per 30 days |
| Wellcare Simple (HMO) (H0174-014) (TX) | Tiers 1–4 | No | No | 59 per 30 days |
| Wellcare Simple (HMO) (H0174-015) (TX) | Tiers 1–4 | No | No | 59 per 30 days |
| Wellcare Simple (HMO) (H0174-016) (TX) | Tiers 1–4 | No | No | 59 per 30 days |
| Wellcare Giveback (HMO) (H0174-017) (TX) | Tiers 1–4 | No | No | 59 per 30 days |
| Wellcare Giveback (HMO) (H0174-018) (TX) | Tiers 1–4 | No | No | 59 per 30 days |
| Wellcare Giveback (HMO) (H0174-019) (TX) | Tiers 1–4 | No | No | 59 per 30 days |
| Wellcare Giveback (HMO) (H0174-020) (TX) | Tiers 1–4 | No | No | 59 per 30 days |
| Wellcare Giveback (HMO) (H0174-021) (TX) | Tiers 1–4 | No | No | 59 per 30 days |
| Wellcare Simple Open (PPO) (H0270-001) (AR) | Tiers 1–4 | No | No | 59 per 30 days |
| Blue Best Life Classic (HMO) (H0302-006) (AZ) | Tiers 1–4 | No | No | None |
| Blue Best Life Classic (HMO) (H0302-008) (AZ) | Tiers 1–4 | No | No | None |
| Wellcare Specialty Simple (HMO C-SNP) (H0351-038) (AZ) | Tiers 1–4 | No | No | 59 per 30 days |
| Wellcare Simple (HMO) (H0351-053) (AZ) | Tiers 1–4 | No | No | 59 per 30 days |
| Wellcare Giveback (HMO) (H0351-054) (AZ) | Tiers 1–4 | No | No | 59 per 30 days |
| Wellcare Specialty Simple (HMO C-SNP) (H0351-057) (AZ) | Tiers 1–4 | No | No | 59 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): $0.22092/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=metronidazole-topical