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.
SYMPROIC (Naldemedine)
Found on the formularies of 201 of 5499 Medicare Part D plans in this dataset · Tiers 1–4 · prior authorization on 44 plans (22%) · quantity limits on 193 (96%), 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 |
|---|---|---|---|---|
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) (H3127-001) (MI) | Tier 1 | No | No | 30 per 30 days |
| HAP CareSource MI Coordinated Health (HMO D-SNP) (H4193-001) (MI) | Tier 1 | No | No | 30 per 30 days |
| ElderServe MAP (HMO D-SNP) (H6776-002) (NY) | Tier 1 | No | No | 30 per 30 days |
| Cooperative Advantage (HMO D-SNP) (H7598-003) (WI) | Tier 1 | No | No | 30 per 30 days |
| CareSource Dual Advantage (HMO D-SNP) (H8390-015) (GA) | Tier 1 | No | No | 30 per 30 days |
| Longevity Health Plan (PPO I-SNP) (H9942-002) (NJ) | Tier 1 | No | No | 30 per 30 days |
| Longevity Health Plan (HMO I-SNP) (H1644-001) (FL) | Tier 1 | No | No | 30 per 30 days |
| Longevity Health Plan (HMO I-SNP) (H7557-001) (MI) | Tier 1 | No | No | 30 per 30 days |
| Longevity Health Plan (HMO I-SNP) (H9590-001) (IL) | Tier 1 | No | No | 30 per 30 days |
| WellSense Added Value (HMO) (H6851-001) (NH) | Tier 1 | No | No | 30 per 30 days |
| Longevity Health Plan (HMO I-SNP) (H0363-001) (CO) | Tier 1 | No | No | 30 per 30 days |
| Longevity Health Plan (HMO I-SNP) (H5374-001) (NC) | Tier 1 | No | No | 30 per 30 days |
| Longevity Health Plan (PPO I-SNP) (H9942-001) (NJ) | Tier 1 | No | No | 30 per 30 days |
| ElderServe Star (HMO I-SNP) (H6776-001) (NY) | Tier 1 | No | No | 30 per 30 days |
| Longevity Health Plan (HMO I-SNP) (H8457-001) (NY) | Tier 1 | No | No | 30 per 30 days |
| Blue adVantage Liberty (PPO) (H1248-007) (LA) | Tier 3 | No | No | 30 per 30 days |
| Blue adVantage Thrive (PPO) (H1248-014) (LA) | Tier 3 | No | No | 30 per 30 days |
| Select Health Medicare Essential (HMO) (H1994-001) (UT) | Tier 3 | No | No | 30 per 30 days |
| Select Health Medicare Essential (HMO) (H1994-012) (NV) | Tier 3 | No | No | 30 per 30 days |
| Select Health Medicare Dual (HMO D-SNP) (H1994-015) (UT) | Tier 3 | No | No | 30 per 30 days |
| Select Health Medicare Essential (HMO) (H1994-017) (UT) | Tier 3 | No | No | 30 per 30 days |
| Select Health Medicare + Kroger (HMO) (H1994-021) (NV) | Tier 3 | No | No | 30 per 30 days |
| Select Health Medicare + Kroger (HMO) (H1994-022) (UT) | Tier 3 | No | No | 30 per 30 days |
| Select Health Medicare Essential (HMO) (H1994-027) (CO) | Tier 3 | No | No | 30 per 30 days |
| Select Health Medicare Essential (HMO) (H1994-029) (CO) | Tier 3 | No | No | 30 per 30 days |
One row per plan — showing 25 of 201 plans; a Yes means the flag applies to at least one form/strength on that plan.
Acquisition cost (NADAC): $16.25157/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=naldemedine