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.
Empaveli (Pegcetacoplan)
Complement Inhibitor
Found on the formularies of 179 of 5499 Medicare Part D plans in this dataset · Tiers 1–5 · prior authorization on 179 plans (100%) · quantity limits on 42 (23%), 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 |
|---|---|---|---|---|
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) (H4093-004) (PA) | Tier 1 | Yes | No | None |
| Provider Partners North Carolina Community Plan (HMO I-SNP) (H4439-002) (NC) | Tier 1 | Yes | No | None |
| Provider Partners Indiana Community Plan (HMO I-SNP) (H4444-002) (IN) | Tier 1 | Yes | No | None |
| Tufts Health One Care (HMO D-SNP) (H5314-001) (MA) | Tier 1 | Yes | No | None |
| Tufts Health One Care CW (HMO D-SNP) (H5314-002) (MA) | Tier 1 | Yes | No | None |
| Provider Partners Maryland Community Plan (HMO I-SNP) (H8067-003) (MD) | Tier 1 | Yes | No | None |
| Tufts Health Plan Senior Care Options (HMO D-SNP) (H8330-001) (MA) | Tier 1 | Yes | No | None |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) (H8330-002) (MA) | Tier 1 | Yes | No | None |
| NaviCare (HMO D-SNP) (H8928-001) (MA) | Tier 1 | Yes | No | 200 per 28 days |
| Provider Partners Missouri Community Plan (HMO I-SNP) (H9191-004) (MO) | Tier 1 | Yes | No | None |
| Provider Partners Texas Advantage Plan (HMO I-SNP) (H4054-001) (TX) | Tier 1 | Yes | No | None |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) (H3800-001) (IL) | Tier 1 | Yes | No | None |
| Provider Partners Maryland Advantage Plan (HMO I-SNP) (H8067-001) (MD) | Tier 1 | Yes | No | None |
| Provider Partners Maryland Essential Plan (HMO I-SNP) (H8067-004) (MD) | Tier 1 | Yes | No | None |
| Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) (H4093-001) (PA) | Tier 1 | Yes | No | None |
| Provider Partners Pennsylvania Essential Plan (HMO I-SNP) (H4093-008) (PA) | Tier 1 | Yes | No | None |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) (H4439-001) (NC) | Tier 1 | Yes | No | None |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) (H4439-003) (NC) | Tier 1 | Yes | No | None |
| Provider Partners Indiana Advantage Plan (HMO I-SNP) (H4444-001) (IN) | Tier 1 | Yes | No | None |
| Provider Partners Indiana Essential Plan (HMO I-SNP) (H4444-003) (IN) | Tier 1 | Yes | No | None |
| Provider Partners Kentucky Advantage Plan (HMO I-SNP) (H7275-001) (KY) | Tier 1 | Yes | No | None |
| Provider Partners Missouri Advantage Plan (HMO I-SNP) (H9191-001) (MO) | Tier 1 | Yes | No | None |
| Provider Partners Missouri Essential Plan (HMO I-SNP) (H9191-005) (MO) | Tier 1 | Yes | No | None |
| CalOptima Health OneCare Complete (HMO D-SNP) (H5433-001) (CA) | Tier 2 | Yes | No | 160 per 28 days |
| Blue Best Life Classic (HMO) (H0302-006) (AZ) | Tier 5 | Yes | No | None |
One row per plan — showing 25 of 179 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=pegcetacoplan