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.
PALSONIFY (Paltusotine)
Found on the formularies of 46 of 5499 Medicare Part D plans in this dataset · Tiers 1–5 · prior authorization on 46 plans (100%) · quantity limits on 46 (100%), 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 |
|---|---|---|---|---|
| Mass General Brigham SCO (HMO D-SNP) (H0777-001) (MA) | Tier 1 | Yes | No | 60 per 30 days |
| Mass General Brigham One Care (HMO D-SNP) (H1611-001) (MA) | Tier 1 | Yes | No | 60 per 30 days |
| NaviCare (HMO D-SNP) (H8928-001) (MA) | Tier 1 | Yes | No | 60 per 30 days |
| UPMC for Life HMO Premier Rx (HMO) (H3907-059) (segment 1) (PA) | Tier 5 | Yes | No | 60 per 30 days |
| UPMC for Life HMO Premier Rx (HMO) (H3907-059) (segment 2) (PA) | Tier 5 | Yes | No | 60 per 30 days |
| UPMC for Life HMO Premier Rx (HMO) (H3907-059) (segment 3) (PA) | Tier 5 | Yes | No | 60 per 30 days |
| UPMC for Life HMO Premier Rx (HMO) (H3907-059) (segment 4) (PA) | Tier 5 | Yes | No | 60 per 30 days |
| UPMC for Life HMO Premier Rx (HMO) (H3907-059) (segment 5) (PA) | Tier 5 | Yes | No | 60 per 30 days |
| UPMC for Life Complete Care (HMO D-SNP) (H4279-001) (PA) | Tier 5 | Yes | No | 60 per 30 days |
| UPMC for Life Complete Care (HMO D-SNP) (H4279-004) (PA) | Tier 5 | Yes | No | 60 per 30 days |
| UPMC for Life PPO Premier Rx (PPO) (H5533-011) (PA) | Tier 5 | Yes | No | 60 per 30 days |
| UPMC for Life PPO Premier Rx (PPO) (H5533-013) (PA) | Tier 5 | Yes | No | 60 per 30 days |
| UPMC for Life PPO Essential Care Rx (PPO) (H5533-017) (segment 1) (PA) | Tier 5 | Yes | No | 60 per 30 days |
| UPMC for Life PPO Essential Care Rx (PPO) (H5533-017) (segment 2) (PA) | Tier 5 | Yes | No | 60 per 30 days |
| UPMC for Life Complete Care (HMO D-SNP) (H7123-001) (PA) | Tier 5 | Yes | No | 60 per 30 days |
| Fallon Medicare Plus Orange (HMO) (H9001-038) (MA) | Tier 5 | Yes | No | 60 per 30 days |
| Mass General Brigham Advantage (PPO) (H9485-001) (MA) | Tier 5 | Yes | No | 60 per 30 days |
| UPMC for Life HMO Rx Choice (HMO) (H3907-057) (segment 1) (PA) | Tier 5 | Yes | No | 60 per 30 days |
| UPMC for Life HMO Rx Choice (HMO) (H3907-057) (segment 2) (OH,PA) | Tier 5 | Yes | No | 60 per 30 days |
| UPMC for Life HMO Rx Choice (HMO) (H3907-057) (segment 3) (PA) | Tier 5 | Yes | No | 60 per 30 days |
| UPMC for Life HMO Rx Choice (HMO) (H3907-057) (segment 6) (PA) | Tier 5 | Yes | No | 60 per 30 days |
| UPMC for Life HMO Rx Choice (HMO) (H3907-057) (segment 4) (PA) | Tier 5 | Yes | No | 60 per 30 days |
| UPMC for Life HMO Rx Choice (HMO) (H3907-057) (segment 5) (PA) | Tier 5 | Yes | No | 60 per 30 days |
| UPMC for Life HMO Rx Choice (HMO) (H3907-057) (segment 7) (PA) | Tier 5 | Yes | No | 60 per 30 days |
| UPMC for Life HMO Deductible Rx (HMO) (H3907-037) (OH,PA) | Tier 5 | Yes | No | 60 per 30 days |
One row per plan — showing 25 of 46 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=paltusotine