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.
JOURNAVX (Suzetrigine)
Sodium Channel Blocker
Found on the formularies of 2770 of 5499 Medicare Part D plans in this dataset · Tiers 1–4 · prior authorization on 1371 plans (49%) · step therapy on 20 (1%) · quantity limits on 1955 (71%), 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 |
|---|---|---|---|---|
| MetroPlus UltraCare (HMO D-SNP) (H0423-007) (NY) | Tier 1 | Yes | No | 29 per 14 days |
| Mass General Brigham SCO (HMO D-SNP) (H0777-001) (MA) | Tier 1 | Yes | No | 29 per 14 days |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) (H1225-003) (MD) | Tier 1 | Yes | No | 29 per 14 days |
| CCA One Care (HMO D-SNP) (H1486-001) (MA) | Tier 1 | Yes | No | 29 per 14 days |
| Mass General Brigham One Care (HMO D-SNP) (H1611-001) (MA) | Tier 1 | Yes | No | 29 per 14 days |
| Senior Whole Health SCO (HMO D-SNP) (H2224-001) (MA) | Tier 1 | Yes | No | 29 per 14 days |
| Senior Whole Health SCO NHC (HMO D-SNP) (H2224-003) (MA) | Tier 1 | Yes | No | 29 per 14 days |
| CCA Senior Care Options (HMO D-SNP) (H2225-001) (MA) | Tier 1 | Yes | No | 29 per 14 days |
| IMCare Classic (HMO D-SNP) (H2417-001) (MN) | Tier 1 | Yes | No | 29 per 14 days |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) (H3127-001) (MI) | Tier 1 | No | No | 30 per 90 days |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) (H3347-007) (NY) | Tier 1 | Yes | No | 29 per 14 days |
| Healthfirst CompleteCare (HMO D-SNP) (H3359-034) (NY) | Tier 1 | Yes | No | 29 per 14 days |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) (H4093-004) (PA) | Tier 1 | No | No | 30 per 90 days |
| HAP CareSource MI Coordinated Health (HMO D-SNP) (H4193-001) (MI) | Tier 1 | No | No | 30 per 90 days |
| Molina One Care (HMO D-SNP) (H4371-001) (MA) | Tier 1 | Yes | No | 29 per 14 days |
| Provider Partners North Carolina Community Plan (HMO I-SNP) (H4439-002) (NC) | Tier 1 | No | No | 30 per 90 days |
| Provider Partners Indiana Community Plan (HMO I-SNP) (H4444-002) (IN) | Tier 1 | No | No | 30 per 90 days |
| Tufts Health One Care (HMO D-SNP) (H5314-001) (MA) | Tier 1 | No | No | 30 per 90 days |
| Tufts Health One Care CW (HMO D-SNP) (H5314-002) (MA) | Tier 1 | No | No | 30 per 90 days |
| Mercy Care Advantage (HMO D-SNP) (H5580-001) (AZ) | Tier 1 | Yes | No | 29 per 14 days |
| Mercy Care Advantage (HMO D-SNP) (H5580-004) (AZ) | Tier 1 | Yes | No | 29 per 14 days |
| Mercy Care Advantage (HMO D-SNP) (H5580-005) (AZ) | Tier 1 | Yes | No | 29 per 14 days |
| Health Choice Pathway (HMO D-SNP) (H5587-002) (AZ) | Tier 1 | Yes | No | 29 per 14 days |
| Platino Blindao (HMO D-SNP) (H5774-028) (PR) | Tier 1 | No | No | 30.00 per 90 days |
| Platino Enlace (HMO D-SNP) (H5774-035) (PR) | Tier 1 | No | No | 30.00 per 90 days |
One row per plan — showing 25 of 2770 plans; a Yes means the flag applies to at least one form/strength on that plan.
Acquisition cost (NADAC): $15.413/unit — price effective 07/01/2026
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 07/01/2026 (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=suzetrigine