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.
QELBREE (Viloxazine)
Found on the formularies of 16 of 5499 Medicare Part D plans in this dataset · Tiers 2–4 · prior authorization on 1 plans (6%) · step therapy on 15 (94%) · quantity limits on 16 (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 |
|---|---|---|---|---|
| CareAdvantage (HMO D-SNP) (H6019-001) (CA) | Tier 2 | Yes | No | 60 per 30 days |
| Select Health Medicare Essential (HMO) (H1994-001) (UT) | Tier 4 | No | Yes | 90 per 30 days |
| Select Health Medicare Essential (HMO) (H1994-012) (NV) | Tier 4 | No | Yes | 90 per 30 days |
| Select Health Medicare Dual (HMO D-SNP) (H1994-015) (UT) | Tier 4 | No | Yes | 90 per 30 days |
| Select Health Medicare Essential (HMO) (H1994-017) (UT) | Tier 4 | No | Yes | 90 per 30 days |
| Select Health Medicare + Kroger (HMO) (H1994-021) (NV) | Tier 4 | No | Yes | 90 per 30 days |
| Select Health Medicare + Kroger (HMO) (H1994-022) (UT) | Tier 4 | No | Yes | 90 per 30 days |
| Select Health Medicare Essential (HMO) (H1994-027) (CO) | Tier 4 | No | Yes | 90 per 30 days |
| Select Health Medicare Essential (HMO) (H1994-029) (CO) | Tier 4 | No | Yes | 90 per 30 days |
| Select Health Medicare + Kroger (HMO) (H1994-030) (CO) | Tier 4 | No | Yes | 90 per 30 days |
| Select Health Medicare Flex (HMO) (H1994-031) (CO) | Tier 4 | No | Yes | 90 per 30 days |
| Select Health Medicare + Kroger (HMO) (H1994-034) (CO) | Tier 4 | No | Yes | 90 per 30 days |
| Select Health Medicare Active (HMO) (H1994-035) (CO) | Tier 4 | No | Yes | 90 per 30 days |
| Select Health Medicare Dual (HMO D-SNP) (H1994-040) (NV) | Tier 4 | No | Yes | 90 per 30 days |
| Select Health Medicare Wellness (HMO) (H1994-044) (NV) | Tier 4 | No | Yes | 90 per 30 days |
| Healthy Mississippi Premier Advantage (HMO-POS) (H8879-001) (MS) | Tier 4 | No | Yes | 90 per 30 days |
One row per plan; a Yes means the flag applies to at least one form/strength on that plan.
Acquisition cost (NADAC): $12.73227/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=viloxazine