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.
ONGENTYS (Opicapone)
Catechol-O-Methyltransferase Inhibitor
Found on the formularies of 368 of 5499 Medicare Part D plans in this dataset · Tiers 1–4 · prior authorization on 47 plans (13%) · step therapy on 16 (4%) · quantity limits on 60 (16%), 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 |
|---|---|---|---|---|
| Community Care's Partnership Program (HMO D-SNP) (H2034-001) (WI) | Tier 1 | No | No | None |
| Alameda Alliance Wellness (HMO D-SNP) (H2035-001) (CA) | Tier 1 | No | Yes | None |
| SeniorCare Complete (HMO D-SNP) (H2419-001) (MN) | Tier 1 | No | Yes | None |
| AbilityCare (HMO D-SNP) (H5703-001) (MN) | Tier 1 | No | Yes | None |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) (H1526-004) (FL) | Tier 1 | Yes | No | 30 per 30 days |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) (H4869-014) (AZ) | Tier 1 | Yes | No | 30 per 30 days |
| CalOptima Health OneCare Complete (HMO D-SNP) (H5433-001) (CA) | Tier 2 | No | No | 30 per 30 days |
| HealthSpring Preferred (HMO) (H0354-001) (AZ) | Tier 3 | No | No | None |
| HealthSpring Achieve (HMO C-SNP) (H0354-027) (AZ) | Tier 3 | No | No | None |
| HealthSpring Alliance (HMO) (H0354-028) (AZ) | Tier 3 | No | No | None |
| HealthSpring Preferred Savings (HMO) (H0354-029) (AZ) | Tier 3 | No | No | None |
| HealthSpring Preferred Full Savings (HMO) (H0354-030) (AZ) | Tier 3 | No | No | None |
| HealthSpring Preferred GA (HMO) (H0439-003) (segment 1) (GA) | Tier 3 | No | No | None |
| HealthSpring Preferred (HMO) (H0439-008) (GA) | Tier 3 | No | No | None |
| HealthSpring Preferred (HMO) (H0439-009) (GA) | Tier 3 | No | No | None |
| HealthSpring Preferred (HMO) (H0439-010) (GA) | Tier 3 | No | No | None |
| HealthSpring Preferred (HMO) (H0439-011) (GA) | Tier 3 | No | No | None |
| HealthSpring TotalCare Plus (HMO D-SNP) (H0439-012) (GA) | Tier 3 | No | No | None |
| HealthSpring Preferred (HMO) (H0439-013) (GA) | Tier 3 | No | No | None |
| HealthSpring Preferred (HMO) (H0439-015) (segment 1) (GA) | Tier 3 | No | No | None |
| HealthSpring Preferred (HMO) (H0439-015) (segment 2) (GA) | Tier 3 | No | No | None |
| HealthSpring Preferred Savings (HMO) (H0439-016) (GA) | Tier 3 | No | No | None |
| HealthSpring Preferred Savings (HMO) (H0439-017) (GA) | Tier 3 | No | No | None |
| HealthSpring Preferred Savings (HMO) (H0439-018) (GA) | Tier 3 | No | No | None |
| HealthSpring Preferred Savings (HMO) (H0439-019) (GA) | Tier 3 | No | No | None |
One row per plan — showing 25 of 368 plans; a Yes means the flag applies to at least one form/strength on that plan.
Acquisition cost (NADAC): $24.66795/unit — price effective 01/05/2026
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 01/05/2026 (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=opicapone