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.
PONVORY (Ponesimod)
Sphingosine 1-phosphate Receptor Modulator
Found on the formularies of 16 of 5499 Medicare Part D plans in this dataset · Tiers 1–5 · prior authorization on 16 plans (100%) · quantity limits on 9 (56%), 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 |
|---|---|---|---|---|
| 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 |
| AbilityCare (HMO D-SNP) (H5703-001) (MN) | Tier 1 | Yes | No | None |
| CalOptima Health OneCare Complete (HMO D-SNP) (H5433-001) (CA) | Tier 2 | Yes | No | None |
| AmeriHealth Caritas VIP Care (HMO D-SNP) (H0738-001) (DE) | Tier 5 | Yes | No | 30 per 30 days |
| AmeriHealth Caritas VIP Care Choice (HMO D-SNP) (H0738-002) (DE) | Tier 5 | Yes | No | 30 per 30 days |
| AmeriHealth Caritas VIP Care (HMO D-SNP) (H2564-001) (LA) | Tier 5 | Yes | No | 30 per 30 days |
| Keystone First VIP Choice (HMO D-SNP) (H4227-001) (PA) | Tier 5 | Yes | No | 30 per 30 days |
| AmeriHealth Caritas VIP Care (HMO D-SNP) (H4227-002) (PA) | Tier 5 | Yes | No | 30 per 30 days |
| Troy Medicare (HMO) (H4676-001) (NC) | Tier 5 | Yes | No | None |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) (H4676-002) (NC) | Tier 5 | Yes | No | None |
| First Choice VIP Care (HMO D-SNP) (H4739-001) (SC) | Tier 5 | Yes | No | 30 per 30 days |
| Contra Costa Health Care Plus (HMO D-SNP) (H5119-001) (CA) | Tier 5 | Yes | No | None |
| AmeriHealth Caritas VIP Care (HMO D-SNP) (H6341-001) (MI) | Tier 5 | Yes | No | 30 per 30 days |
| AmeriHealth Caritas VIP Care (HMO D-SNP) (H6378-001) (FL) | Tier 5 | Yes | No | 30 per 30 days |
| AmeriHealth Caritas VIP Care (HMO D-SNP) (H8212-001) (NC) | Tier 5 | Yes | No | 30 per 30 days |
One row per plan; 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=ponesimod