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.
Galafold (Migalastat)
Found on the formularies of 164 of 5499 Medicare Part D plans in this dataset · Tiers 1–5 · prior authorization on 164 plans (100%) · quantity limits on 86 (52%), 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 | 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 |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) (H1526-004) (FL) | Tier 1 | Yes | No | 14 per 28 days |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) (H4869-014) (AZ) | Tier 1 | Yes | No | 14 per 28 days |
| CalOptima Health OneCare Complete (HMO D-SNP) (H5433-001) (CA) | Tier 2 | Yes | No | 14 per 28 days |
| VNS Health Total (HMO D-SNP) (H5549-003) (NY) | Tier 4 | Yes | No | 14 per 28 days |
| PHP (HMO C-SNP) (H5852-001) (CA) | Tier 4 | Yes | No | 14 per 28 days |
| VNS Health EasyCare Plus (HMO D-SNP) (H5549-011) (NY) | Tier 4 | Yes | No | 14 per 28 days |
| AmeriHealth Caritas VIP Care (HMO D-SNP) (H0738-001) (DE) | Tier 5 | Yes | No | None |
| AmeriHealth Caritas VIP Care Choice (HMO D-SNP) (H0738-002) (DE) | Tier 5 | Yes | No | None |
| Gold Heart & Diabetes (HMO-POS C-SNP) (H1526-001) (FL) | Tier 5 | Yes | No | 14 per 28 days |
| Gold Heart & Diabetes Complete (HMO-POS C-SNP) (H1526-002) (FL) | Tier 5 | Yes | No | 14 per 28 days |
| Gold Dialysis & Kidney (HMO-POS C-SNP) (H1526-003) (FL) | Tier 5 | Yes | No | 14 per 28 days |
| Gold Health (HMO-POS C-SNP) (H1526-008) (FL) | Tier 5 | Yes | No | 14 per 28 days |
| Gold Dialysis & Kidney (HMO-POS C-SNP) (H1526-009) (FL) | Tier 5 | Yes | No | 14 per 28 days |
| VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) (H2168-001) (NY) | Tier 5 | Yes | No | 14 per 28 days |
| VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) (H2168-002) (NY) | Tier 5 | Yes | No | 14 per 28 days |
| AmeriHealth Caritas VIP Care (HMO D-SNP) (H2564-001) (LA) | Tier 5 | Yes | No | None |
| SummaCare Medicare Topaz (HMO) (H3660-050) (OH) | Tier 5 | Yes | No | 14 per 28 days |
| SummaCare Medicare Quartz (HMO) (H3660-057) (OH) | Tier 5 | Yes | No | 14 per 28 days |
| Personal Choice 65 Achieve Rx (PPO) (H3909-020) (PA) | Tier 5 | Yes | No | 14 per 28 days |
| Keystone 65 Focus Rx (HMO-POS) (H3952-053) (PA) | Tier 5 | Yes | No | 14 per 28 days |
| Keystone 65 Focus Rx (HMO-POS) (H3952-054) (PA) | Tier 5 | Yes | No | 14 per 28 days |
| Keystone 65 Basic Rx (HMO) (H3952-055) (PA) | Tier 5 | Yes | No | 14 per 28 days |
One row per plan — showing 25 of 164 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=migalastat