Medicare Formulary Lookup

Search a medication to see its typical Medicare Part D formulary tier, restrictions like prior authorization or step therapy, an estimated monthly cost, and lower-cost generic alternatives. These are educational estimates — your exact coverage depends on your specific plan.

Every Medicare Part D and Medicare Advantage plan has its own formulary — the list of drugs it covers and what tier each one sits on. Search a medication below for typical coverage, restrictions, and generic alternatives. For your exact copay, compare Part D plans.

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How Part D Formularies Work

What is a formulary?

The list of drugs your Medicare Part D or Medicare Advantage plan covers, organized into pricing tiers.

What are drug tiers?

Tiers group covered drugs by cost — Tier 1–2 are low-cost generics, Tier 3 preferred brands, Tier 4 non-preferred, Tier 5 specialty drugs.

What is prior authorization?

Your plan must approve the drug before covering it, usually to confirm it's medically necessary.

What is step therapy?

You may need to try one or more lower-cost drugs first before the plan covers a more expensive option.

What are quantity limits?

Plans may limit how much of a drug they cover over a period of time for safety or cost reasons.

What if my drug is not covered?

You can request a formulary exception and appeal, switch to a covered alternative, or compare plans during enrollment. We can help.

Frequently Asked Questions

Does Medicare cover Ozempic?

Medicare Part D plans typically cover Ozempic when it is prescribed for type 2 diabetes, usually on a higher brand tier and often with prior authorization. It is generally not covered for weight loss alone.

What is a formulary?

A formulary is the list of drugs a Medicare Part D or Medicare Advantage plan covers, organized into pricing tiers.

What are drug tiers?

Tiers group covered drugs by cost. Lower tiers (1–2) are generics with low copays; higher tiers (3–5) are preferred brands, non-preferred brands, and specialty drugs with higher costs.

What is prior authorization?

Prior authorization means your plan must approve a drug before it will cover it, usually to confirm it is medically necessary.

What is step therapy?

Step therapy requires you to try one or more lower-cost drugs first before the plan covers a more expensive option.

Can I appeal a coverage denial?

Yes. If your plan denies coverage, you can request an exception and file an appeal. A licensed agent or your doctor can help with the paperwork.

Sources

Medicare.gov — drug coverage (Part D) — Medicare.gov
Medicare Plan Finder — Medicare.gov

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