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.
Nucynta (Tapentadol)
Found on the formularies of 79 of 5499 Medicare Part D plans in this dataset · Tiers 4–5 · prior authorization on 79 plans (100%) · quantity limits on 79 (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 |
|---|---|---|---|---|
| Alignment Health the ONE + Walgreens (HMO) (H3443-001) (AZ) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health the ONE + Walgreens (HMO) (H3443-002) (AZ) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health Heart & Diabetes (HMO C-SNP) (H3443-003) (AZ) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health smartHMO (HMO) (H3443-005) (AZ) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health My Choice (HMO) (H3815-001) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health Platinum + Instacart (HMO) (H3815-008) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health Heart & Diabetes (HMO C-SNP) (H3815-010) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health AllCare Preferred (HMO) (H3815-011) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health smartHMO (HMO) (H3815-013) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health Platinum + Instacart (HMO-POS) (H3815-016) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health My Choice (HMO) (H3815-028) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health Harmony (HMO) (H3815-031) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health Balance (HMO C-SNP) (H3815-033) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health the ONE (HMO) (H3815-034) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health the ONE + Walgreens (HMO) (H3815-035) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health smartHMO (HMO) (H3815-038) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health smartHMO (HMO) (H3815-040) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health CommUnity (HMO) (H3815-046) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health smartSavings (HMO) (H3815-047) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) (H3815-048) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health My Choice Select (HMO) (H3815-049) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health My Choice CalCare (HMO) (H3815-050) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health Honor+ Plan (HMO) (H3815-052) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health ValorCare (HMO) (H3815-053) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) (H3815-054) (CA) | Tiers 4–5 | Yes | No | 60 per 30 days |
One row per plan — showing 25 of 79 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=tapentadol