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Addiction Medication Formulary & PA Lookup
Pick a plan and a medication. We surface the coverage shape — tier, prior auth, step therapy, quantity limit — with the source and freshness date on every result.
Plan + drug only — no PHI. Don't enter member IDs, names, or DOBs. The lookup never sees patient data.
Lookup
What this covers
Pick a plan to start. The tool covers the addiction medications most often blocked by formulary friction:
- Buprenorphine/naloxone (films, tablets, monoproduct)
- Sublocade (buprenorphine extended-release)
- Methadone for OUD (OTP-administered)
- Naltrexone — oral and Vivitrol
- Acamprosate, disulfiram
- Naloxone nasal spray
Honest scope: Medicare Part D uses a curated quarterly pattern from CMS formulary files, not a live plan-specific lookup. Commercial plans (Aetna, UHC, Cigna, BCBS) and state Medicaid don't publish a clean machine-readable feed, so for those the tool returns the right set of questions to ask the PBM line — not a fabricated coverage answer.
This is a navigation aid, not a coverage determination. Formulary and prior-authorization rules change without notice and vary by specific plan, line of business, and benefit year. The payer's actual determination at point of service is the only authoritative answer — call the member-services or PBM line on the back of the patient's insurance card before counting on coverage. Medicare Part D summary data is aggregated from the CMS Quarterly Prescription Drug Plan Formulary file; NADAC figures are pharmacist's acquisition cost, not retail price.