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.
Annovera (Segesterone and Ethinyl Estradiol)
Estrogen
Found on the formularies of 44 of 5499 Medicare Part D plans in this dataset · Tiers 2–4 · quantity limits on 43 (98%), 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 |
|---|---|---|---|---|
| CalOptima Health OneCare Complete (HMO D-SNP) (H5433-001) (CA) | Tier 2 | No | No | None |
| CareAdvantage (HMO D-SNP) (H6019-001) (CA) | Tier 2 | No | No | 1 per 365 days |
| DrMax (HMO) (H4140-001) (FL) | Tier 3 | No | No | 1 per 364 days |
| DrExtraCare (HMO C-SNP) (H4140-004) (FL) | Tier 3 | No | No | 1 per 364 days |
| DrSelect (HMO) (H4140-012) (FL) | Tier 3 | No | No | 1 per 364 days |
| DrSelect-CFL (HMO) (H4140-016) (FL) | Tier 3 | No | No | 1 per 364 days |
| DrPlatinum-CFL (HMO D-SNP) (H4140-017) (FL) | Tier 3 | No | No | 1 per 364 days |
| DrTotalCare-CFL (HMO C-SNP) (H4140-018) (FL) | Tier 3 | No | No | 1 per 364 days |
| DrElite-SFL (HMO) (H4140-019) (FL) | Tier 3 | No | No | 1 per 364 days |
| DrFlex (HMO D-SNP) (H4140-013) (FL) | Tier 3 | No | No | 1 per 364 days |
| DrPlus (HMO D-SNP) (H4140-002) (FL) | Tier 3 | No | No | 1 per 364 days |
| Medicare BlueEssential (PPO) (H3335-053) (NY) | Tier 4 | No | No | 1 per 365 days |
| Medicare BlueActive (PPO) (H3335-055) (NY) | Tier 4 | No | No | 1 per 365 days |
| Medicare BlueVital (PPO) (H3335-061) (NY) | Tier 4 | No | No | 1 per 365 days |
| Univera SeniorChoice Basic (HMO) (H3351-017) (NY) | Tier 4 | No | No | 1 per 365 days |
| Univera SeniorChoice Extra (HMO) (H3351-020) (NY) | Tier 4 | No | No | 1 per 365 days |
| Medicare Blue Choice Core (HMO) (H3351-022) (NY) | Tier 4 | No | No | 1 per 365 days |
| CDPHP $0 Medicare Rx (HMO) (H3388-014) (NY) | Tier 4 | No | No | 1 per 365 days |
| Geisinger Gold Preferred Complete Rx (PPO) (H3924-065) (PA) | Tier 4 | No | No | 1 per 365 days |
| Geisinger Gold Secure Rx (HMO D-SNP) (H3954-097) (PA) | Tier 4 | No | No | 1 per 365 days |
| Geisinger Gold Classic 360 Rx (HMO) (H3954-160) (PA) | Tier 4 | No | No | 1 per 365 days |
| Geisinger Gold Classic Essential Rx (HMO) (H3954-161) (PA) | Tier 4 | No | No | 1 per 365 days |
| Univera Medicare Dual (HMO D-SNP) (H7524-001) (NY) | Tier 4 | No | No | 1 per 365 days |
| Medicare Blue Dual (HMO D-SNP) (H7524-003) (NY) | Tier 4 | No | No | 1 per 365 days |
| Geisinger Gold Value Rx (HMO) (H3954-163) (PA) | Tier 4 | No | No | 1 per 365 days |
One row per plan — showing 25 of 44 plans; a Yes means the flag applies to at least one form/strength on that plan.
Acquisition cost (NADAC): $2315.53043/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=segesterone-and-ethinyl-estradiol