apomorphine hydrochloride

10 MG

Dopaminergic Agonist

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Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 13 hours, 22 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Standard Gold + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze Tier 5 - Specialty ✓ — ✓ PA | QL
Clear Silver with $0 Insulin Options Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Focused Silver with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Focused Silver with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 13 hours, 22 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
HumanaChoice H5525-049 (PPO) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
HumanaChoice H5525-050 (PPO) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
HumanaChoice H5525-070 (PPO) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Dual Select H5525-072 (PPO D-SNP) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
HumanaChoice H5525-083 (PPO) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus H6622-025 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus H6622-026 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Dual Select H6622-027 (HMO-POS D-SNP) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus H6622-057 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus H6622-060 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus H6622-061 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Choice H8145-004 (PFFS) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Blue Medicare PPO Enhanced (PPO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Blue Medicare Essential Plus (HMO-POS) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Blue Medicare Enhanced (HMO-POS) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Blue Medicare Choice (HMO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Blue Medicare Essential (HMO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Experience Health Medicare Advantage (HMO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Platinum (HMO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health NC Duals (HMO-POS D-SNP) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health smartHMO (HMO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Platinum Select (HMO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health AVA (PPO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Troy Medicare (HMO) Tier 5 - Specialty ✓ — — PA
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
Humana Gold Plus H1036-137 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus H1036-233 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Dual Select H1036-307 (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus Giveback H1036-318 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus H1036-335 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
HumanaChoice Giveback H5216-017 (PPO) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
HumanaChoice H5216-211 (PPO) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Full Access H5525-034 (PPO) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
HumanaChoice Giveback H5525-035 (PPO) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
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