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.
AQVESME (Mitapivat)
Pyruvate Kinase Activator
Found on the formularies of 1574 of 5499 Medicare Part D plans in this dataset · Tiers 1–6 · prior authorization on 1459 plans (93%) · quantity limits on 1418 (90%), 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 | 7 per 28 days |
| Mass General Brigham SCO (HMO D-SNP) (H0777-001) (MA) | Tier 1 | Yes | No | 7 per 7 days |
| Mass General Brigham One Care (HMO D-SNP) (H1611-001) (MA) | Tier 1 | Yes | No | 7 per 7 days |
| 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 |
| SecureBlue (HMO D-SNP) (H2425-001) (MN) | Tier 1 | Yes | No | 7 per 28 days |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) (H3251-029) (NM) | Tier 1 | Yes | No | 7 per 28 days |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) (H4093-004) (PA) | Tier 1 | Yes | No | 60 per 30 days |
| Provider Partners North Carolina Community Plan (HMO I-SNP) (H4439-002) (NC) | Tier 1 | Yes | No | 60 per 30 days |
| Provider Partners Indiana Community Plan (HMO I-SNP) (H4444-002) (IN) | Tier 1 | Yes | No | 60 per 30 days |
| AbilityCare (HMO D-SNP) (H5703-001) (MN) | Tier 1 | Yes | No | None |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) (H5932-001) (PA) | Tier 1 | Yes | No | 7 per 28 days |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) (H5932-012) (PA) | Tier 1 | Yes | No | 7 per 28 days |
| Highmark Health Options Duals (HMO D-SNP) (H6224-001) (WV) | Tier 1 | Yes | No | 7 per 28 days |
| Highmark Health Options Duals (HMO D-SNP) (H7710-001) (DE) | Tier 1 | Yes | No | 7 per 28 days |
| Provider Partners Maryland Community Plan (HMO I-SNP) (H8067-003) (MD) | Tier 1 | Yes | No | 60 per 30 days |
| Horizon NJ TotalCare (HMO D-SNP) (H8298-001) (NJ) | Tier 1 | Yes | No | 7 per 28 days |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) (H8634-009) (NM) | Tier 1 | Yes | No | 7 per 28 days |
| NaviCare (HMO D-SNP) (H8928-001) (MA) | Tier 1 | Yes | No | 60 per 30 days |
| Provider Partners Missouri Community Plan (HMO I-SNP) (H9191-004) (MO) | Tier 1 | Yes | No | 60 per 30 days |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) (H9623-001) (CA) | Tier 1 | Yes | No | 7 per 28 days |
| Provider Partners Texas Advantage Plan (HMO I-SNP) (H4054-001) (TX) | Tier 1 | Yes | No | 60 per 30 days |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) (H9706-002) (TX) | Tier 1 | Yes | No | 7 per 28 days |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) (H8554-003) (OK) | Tier 1 | Yes | No | 7 per 28 days |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) (H5932-013) (PA) | Tier 1 | Yes | No | 7 per 28 days |
One row per plan — showing 25 of 1574 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=mitapivat