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Does Medicare Part D cover Aptiom?

Aptiom appears on the Medicare Part D formularies of 51 payers in the corpus, across 1,448 plans. 1 payer require prior authorization on every covering plan, 0 on some plans, and 50 on none.

Beyond prior authorization: 9 covering plans require step therapy (another drug tried first) and 1,359 apply a quantity limit, on at least one Aptiom product.

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 authStep therapyQuantity limitStatus
Aetna (CVS Health)65300653No prior authorization
Devoted Health41500415No prior authorization
SCAN Health Plan747400Prior authorization required
Molina Healthcare510051No prior authorization
Zing Health Of Michigan, INC.330033No prior authorization
Blue Cross Blue Shield (affiliate)160016No prior authorization
Excellus Health Plan, INC.160016No prior authorization
Central Health Plan Of California, INC.150015No prior authorization
Clover Health130013No prior authorization
Mount Carmel Health Plan, INC.110011No prior authorization
Allina Health And Aetna Insurance Company9009No prior authorization
Doctors Healthcare Plans, INC.9099No prior authorization
Mvp Health Plan, INC.8008No prior authorization
Keystone Health Plan East, INC.8000No prior authorization
Viva Health, INC.7007No prior authorization
Martin'S Point Generations Advantage, INC.7007No prior authorization
Christus Health Plan6006No prior authorization
Elderplan, INC.6006No prior authorization
Connecticare, INC.6006No prior authorization
Hopkins Health Advantage, INC.5005No prior authorization
Usable Mutual Insurance Company5005No prior authorization
Hpmp Of Florida, INC.5005No prior authorization
Health New England, INC.4004No prior authorization
Hawaii Medical Service Association4004No prior authorization
Qcc Insurance Company4000No prior authorization
Sharp Health Plan4004No prior authorization
Clever Care Of Golden State, INC.4004No prior authorization
Metroplus Health Plan, INC.3003No prior authorization
Mount Carmel Health Insurance Company3003No prior authorization
Senior Whole Health, LLC3003No prior authorization
Capital District Physicians' Health Plan, INC.3003No prior authorization
Paramount Care, INC.3003No prior authorization
Mount Carmel Health Plan Of Idaho, INC.3003No prior authorization
Amerihealth Insurance Company Of New Jersey3000No prior authorization
Mercy Care3003No prior authorization
Usable HMO, INC.3003No prior authorization
Hamaspik, INC.2002No prior authorization
Commonwealth Care Alliance, INC.2002No prior authorization
Neighborhood Health Plan Of Rhode Island2002No prior authorization
Senior Whole Health Of New York, INC.2002No prior authorization
Excellus Health Plan Community Care LLC2002No prior authorization
Trinity Health Plan Of Michigan INC2002No prior authorization
Mount Carmel Health Plan Of New York, INC.2002No prior authorization
Elevance Health (Anthem)2002No prior authorization
Johns Hopkins Health Plan Of Virginia, INC.1001No prior authorization
Itasca Medical Care1001No prior authorization
Connecticare Insurance Company, INC.1001No prior authorization
Paramount Insurance Company1001No prior authorization
Health Choice Arizona, INC.1001No prior authorization
Hawaii Medical Service Association (Hmsa)1001No prior authorization
Healthfirst Insurance Company, INC.1001No prior authorization

“Require prior auth”, “step therapy” and “quantity limit” each count a plan when any Aptiom product on its formulary carries that condition.

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.