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Does Medicare Part D cover Aptiom?

Aptiom appears on the Medicare Part D formularies of 51 payers in the corpus. 1 require prior authorization on every covering plan, 0 on some plans, and 50 on none.

Prior authorization is set per plan, not per payer. Pick a payer below for its full plan-by-plan breakdown, effective 2026-06-30.

Coverage by payer

PayerPlans coveringRequire prior authStatus
Aetna (CVS Health)6530No prior authorization
Devoted Health4150No prior authorization
SCAN Health Plan7474Prior authorization required
Molina Healthcare510No prior authorization
Zing Health Of Michigan, INC.330No prior authorization
Blue Cross Blue Shield (affiliate)160No prior authorization
Excellus Health Plan, INC.160No prior authorization
Central Health Plan Of California, INC.150No prior authorization
Clover Health130No prior authorization
Mount Carmel Health Plan, INC.110No prior authorization
Allina Health And Aetna Insurance Company90No prior authorization
Doctors Healthcare Plans, INC.90No prior authorization
Mvp Health Plan, INC.80No prior authorization
Keystone Health Plan East, INC.80No prior authorization
Viva Health, INC.70No prior authorization
Martin'S Point Generations Advantage, INC.70No prior authorization
Christus Health Plan60No prior authorization
Elderplan, INC.60No prior authorization
Connecticare, INC.60No prior authorization
Hopkins Health Advantage, INC.50No prior authorization
Usable Mutual Insurance Company50No prior authorization
Hpmp Of Florida, INC.50No prior authorization
Health New England, INC.40No prior authorization
Hawaii Medical Service Association40No prior authorization
Qcc Insurance Company40No prior authorization
Sharp Health Plan40No prior authorization
Clever Care Of Golden State, INC.40No prior authorization
Metroplus Health Plan, INC.30No prior authorization
Mount Carmel Health Insurance Company30No prior authorization
Senior Whole Health, LLC30No prior authorization
Capital District Physicians' Health Plan, INC.30No prior authorization
Paramount Care, INC.30No prior authorization
Mount Carmel Health Plan Of Idaho, INC.30No prior authorization
Amerihealth Insurance Company Of New Jersey30No prior authorization
Mercy Care30No prior authorization
Usable HMO, INC.30No prior authorization
Hamaspik, INC.20No prior authorization
Commonwealth Care Alliance, INC.20No prior authorization
Neighborhood Health Plan Of Rhode Island20No prior authorization
Senior Whole Health Of New York, INC.20No prior authorization
Excellus Health Plan Community Care LLC20No prior authorization
Trinity Health Plan Of Michigan INC20No prior authorization
Mount Carmel Health Plan Of New York, INC.20No prior authorization
Elevance Health (Anthem)20No prior authorization
Johns Hopkins Health Plan Of Virginia, INC.10No prior authorization
Itasca Medical Care10No prior authorization
Connecticare Insurance Company, INC.10No prior authorization
Paramount Insurance Company10No prior authorization
Health Choice Arizona, INC.10No prior authorization
Hawaii Medical Service Association (Hmsa)10No prior authorization
Healthfirst Insurance Company, INC.10No prior authorization

“Require prior auth” counts a plan when any Aptiom product on its formulary needs authorization.

Source
Monthly Prescription Drug Plan Formulary and Pharmacy Network Information — Basic Drugs Formulary File
Effective
2026-06-30
Retrieved
2026-07-19
SHA-256
e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae

We publish the hash of the exact file we ingested so any answer can be audited against the bytes CMS served that day.

Administrative information only. Benefily reports what a payer has published in its own prior-authorization policy as of the effective date shown. It is not medical advice, not a coverage or payment guarantee, and not an authorization. Requirements vary by plan, place of service and member benefits — always verify with the payer before rendering service.