Which Medicare Part D plans in this county cover this drug, at what tier and cost? Every PDP and Medicare Advantage drug plan with tier, prior authorization, step therapy, quantity limit, premium and copay, plan years 2026 and 2027, computed by Distill from CMS’s monthly formulary files
medicare_partd_coverageWhich Medicare Part D plans in this county cover this drug, at what tier and cost? Every PDP and Medicare Advantage drug plan with tier, prior authorization, step therapy, quantity limit, premium and copay, plan years 2026 and 2027, computed by Distill from CMS’s monthly formulary files. From CMS’s monthly Part D formulary public use file: every stand-alone (PDP) and Medicare Advantage drug plan sold in the county (by SSA county code, or state and county name), whether its formulary covers the drug (RxCUI, or the NDC the file lists), and on what terms: tier, prior authorization, step therapy, quantity limit, negotiated-drug flag, the plan’s premium and deductible, and the 30-day initial-coverage cost sharing for that tier at each pharmacy type. Covering plans come lowest tier first, then lowest premium. Pass plan_year=2027 for open enrollment. Employer and PACE plans are not in the file. Refreshed monthly (live freshness: /status). Price: $0.02 per call. Free tier: 3 free calls a day per IP, at most 3 rows per answer, taken by an unpaid call unless its _meta["distill/free-tier"] is "skip". Answers in a summary view of about 3,000 tokens; view: "full" for every row. Confidence: Freshness only (the plans and terms are read from the CMS file deterministically): 1 until 45 days after the served file’s date (CMS posts one a month), then halving every 30 days. Medicare Part D formulary and plan data as of the CMS public use file’s date (file_date), processed by Distill; the Medicare Plan Finder (medicare.gov/plan-compare) may have newer information. Not enrollment, coverage or medical advice; confirm with the plan. See /terms.
Tool call template
This tool declares no required parameters. Add optional parameters from the input schema as needed.
{
"id": 1,
"jsonrpc": "2.0",
"method": "tools/call",
"params": {
"arguments": {},
"name": "medicare_partd_coverage"
}
}Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| ndc | No | An 11-digit NDC as the formulary file lists it (one per RxCUI); prefer rxcui. | |
| kind | No | pdp, ma or all (default). | |
| view | No | summary (the default): the answer a model needs, budgeted; full: every row (a free answer stays capped). | |
| limit | No | At most this many plans (default 20). | |
| rxcui | No | The drug’s RxNorm concept id (RxCUI), e.g. 617311 for atorvastatin 40 mg oral tablet. | |
| state | No | Two-letter state code, with county. | |
| county | No | County name, with state, e.g. Denver. | |
| plan_year | No | The plan (benefit) year, e.g. 2027 for open enrollment (default: the current year). | |
| county_code | No | The SSA state-county code, e.g. 06150 (Denver, CO). |