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Does Medicare Part D cover Cystagon?

Cystagon appears on the Medicare Part D formularies of 266 payers in the corpus. 152 require prior authorization on every covering plan, 3 on some plans, and 111 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
Humana8170No prior authorization
UnitedHealthcare7310No prior authorization
Aetna (CVS Health)658653Varies by plan
Devoted Health415415Prior authorization required
Blue Cross Blue Shield (affiliate)269144Varies by plan
Centene (WellCare)197197Prior authorization required
Cigna1710No prior authorization
Kaiser Permanente1150No prior authorization
SCAN Health Plan740No prior authorization
Elevance Health (Anthem)6767Prior authorization required
Alignment Healthcare6767Prior authorization required
Medco Containment Life And Medco Containment Ny600No prior authorization
Molina Healthcare5151Prior authorization required
Simply Healthcare Plans, INC.5050Prior authorization required
Cariten Health Plan INC.440No prior authorization
Uhc Of California400No prior authorization
Priority Health370No prior authorization
Careplus Health Plans, INC.360No prior authorization
Bravo Health Pennsylvania, INC.350No prior authorization
Preferred Care Partners, INC.350No prior authorization
Zing Health Of Michigan, INC.3333Prior authorization required
Health Care Service Corporation3131Prior authorization required
Solis Health Plans, INC.2424Prior authorization required
Sunshine State Health Plan, INC.2424Prior authorization required
Freedom Health, INC.2424Prior authorization required
Capital Advantage Insurance Company2323Prior authorization required
Triple S Advantage, INC.2222Prior authorization required
Physicians Health Choice Of Texas, LLC220No prior authorization
Tufts Associated Health Maintenance Organization210No prior authorization
Mmm Healthcare, LLC200No prior authorization
Mcs Advantage, INC.2020Prior authorization required
Harmony Health Plan, INC.1919Prior authorization required
Hcsc Insurance Services Company1818Prior authorization required
Medica Health Plans1717Prior authorization required
Upmc Health Plan, INC.170No prior authorization
Bluecross Blueshield Of Tennessee, INC.1717Prior authorization required
Wellpoint Texas, INC.1616Prior authorization required
Ultimate Health Plans, INC.160No prior authorization
Excellus Health Plan, INC.160No prior authorization
Medical Mutual Of Ohio1616Prior authorization required
Superior Healthplan, INC.1515Prior authorization required
Florida Blue Medicare, INC.1513Varies by plan
Optimum Healthcare, INC.1515Prior authorization required
Central Health Plan Of California, INC.1515Prior authorization required
Blue Care Network Of Michigan150No prior authorization
Selecthealth, INC.1414Prior authorization required
Wellpoint Insurance Company1414Prior authorization required
Peoples Health, INC.130No prior authorization
Clover Health1313Prior authorization required
Healthsun Health Plans, INC.1313Prior authorization required
Upmc Health Network, INC.120No prior authorization
HMO Louisiana, INC.1212Prior authorization required
Mount Carmel Health Plan, INC.1111Prior authorization required
Pacificsource Community Health Plans1111Prior authorization required
Community Insurance Company1010Prior authorization required
Health Insurance Plan Of Greater New York1010Prior authorization required
HMO Colorado, INC.1010Prior authorization required
Quartz Health Plan Corporation100No prior authorization
Compcare Health Services Insurance Corporation1010Prior authorization required
Sanford Health Plan90No prior authorization
Allina Health And Aetna Insurance Company99Prior authorization required
Geisinger Health Plan90No prior authorization
Doctors Healthcare Plans, INC.90No prior authorization
New York Quality Healthcare Corporation99Prior authorization required
Wellpoint Tennessee, INC.99Prior authorization required
Healthier New Jersey Insurance Company88Prior authorization required
Meridian Health Plan Of Michigan, INC.88Prior authorization required
Healthpartners, INC.80No prior authorization
American Progressive Life & Hlth Ins Company Of Ny88Prior authorization required
Mvp Health Plan, INC.88Prior authorization required
Network Health Insurance Corporation80No prior authorization
Fallon Community Health Plan80No prior authorization
Peak Health Insurance Corporation80No prior authorization
Health Partners Plans, INC.80No prior authorization
Medco Containment Life & Medco Containment Ny & Health Care88Prior authorization required
Viva Health, INC.77Prior authorization required
Martin'S Point Generations Advantage, INC.77Prior authorization required
Wellpoint Health Plans, INC.77Prior authorization required
Bravo Health Mid-Atlantic, INC.70No prior authorization
Health Alliance Plan Of Michigan70No prior authorization
Medica Insurance Company77Prior authorization required
Keystone Health Plan Central, INC.77Prior authorization required
Essence Healthcare PPO, INC.77Prior authorization required
Bluecross And Blueshield Of South Carolina70No prior authorization
Providence Health Assurance70No prior authorization
Mass General Brigham Health Plan, INC66Prior authorization required
Buckeye Community Health Plan, INC.66Prior authorization required
Christus Health Plan66Prior authorization required
Nebraska Total Care, INC.66Prior authorization required
Essence Healthcare, INC.66Prior authorization required
Hometown Health Plan, INC.60No prior authorization
Presbyterian Health Plan60No prior authorization
Elderplan, INC.66Prior authorization required
Perennial Advantage Of Colorado, INC.60No prior authorization
Connecticare, INC.66Prior authorization required
Preferred Care Network, INC.60No prior authorization
Scott And White Health Plan66Prior authorization required
Coordinated Care Of Washington, INC.55Prior authorization required
Hopkins Health Advantage, INC.55Prior authorization required
Alliance Health And Life Insurance Company50No prior authorization
Sapphire Edge, INC.55Prior authorization required
Independent Health Association, INC.50No prior authorization
Coordinated Care Corporation55Prior authorization required
Usable Mutual Insurance Company55Prior authorization required
Meridian Health Plan Of Illinois, INC.55Prior authorization required
Sunflower State Health Plan, INC.55Prior authorization required
Priority Health Choice, INC.50No prior authorization
Arkansas Health & Wellness Health Plan, INC.55Prior authorization required
Hpmp Of Florida, INC.55Prior authorization required
Home State Health Plan, INC.44Prior authorization required
Baylor Scott & White Insurance Company44Prior authorization required
Care N' Care Insurance Company Of North Carolina40No prior authorization
Health New England, INC.40No prior authorization
Pennsylvania Health & Wellness, INC.44Prior authorization required
The Health Plan Of West Virginia, INC.44Prior authorization required
Communitycare Government Programs, INC.40No prior authorization
Hawaii Medical Service Association44Prior authorization required
Security Health Plan Of Wisconsin, INC.40No prior authorization
Sharp Health Plan44Prior authorization required
Gateway Health Plan, INC.44Prior authorization required
Capital Health Plan44Prior authorization required
Boston Medical Center Health Plan, INC.44Prior authorization required
Bluecross Blueshield Kansas Solutions, INC.44Prior authorization required
Clever Care Of Golden State, INC.44Prior authorization required
Central Mass Health, LLC44Prior authorization required
Ghs Insurance Company44Prior authorization required
Thp Insurance Company44Prior authorization required
Amh Health, LLC44Prior authorization required
Dean Health Plan, INC.40No prior authorization
Quartz Health Plan Mn Corporation40No prior authorization
Medisun, INC.30No prior authorization
Metroplus Health Plan, INC.33Prior authorization required
Wellpoint West Virginia , INC.33Prior authorization required
Louisiana Health Service & Indemnity Company33Prior authorization required
Eternalhealth, INC.30No prior authorization
Patrius Health, INC.33Prior authorization required
Marquis Advantage, INC.30No prior authorization
Partners Insurance Company INC30No prior authorization
Mount Carmel Health Insurance Company33Prior authorization required
Community Care Health Plan Of Louisiana, INC.33Prior authorization required
Trillium Community Health Plan, INC.33Prior authorization required
Senior Whole Health, LLC33Prior authorization required
Secur INC30No prior authorization
Wellpoint New Jersey, INC.33Prior authorization required
Volunteer State Health Plan33Prior authorization required
Align Senior Care California INC.30No prior authorization
Pruitthealth Premier, INC.30No prior authorization
Capital District Physicians' Health Plan, INC.30No prior authorization
Procare Advantage, LLC30No prior authorization
Eternalhealth Of Arizona INC30No prior authorization
Paramount Care, INC.33Prior authorization required
Mount Carmel Health Plan Of Idaho, INC.33Prior authorization required
Geisinger Indemnity Insurance Company30No prior authorization
Simpra Advantage, INC.30No prior authorization
Provider Partners Health Plan Of Pennsylvania, INC30No prior authorization
Provider Partners Health Plan Of North Carolina30No prior authorization
Provider Partners Health Plan Of Indiana30No prior authorization
Celtic Insurance Company33Prior authorization required
Mercy Care33Prior authorization required
Usable HMO, INC.33Prior authorization required
Liberty Advantage, LLC30No prior authorization
Managed Health Services Insurance CORP.33Prior authorization required
Perennial Advantage Of Ohio, INC.30No prior authorization
Provider Partners Health Plan Of Missouri, INC.30No prior authorization
Hamaspik, INC.22Prior authorization required
Arizona Physicians Ipa, INC.20No prior authorization
Ks Plan Administrators, LLC20No prior authorization
Carepartners Of Connecticut, INC.20No prior authorization
Amerihealth Caritas Vip Next, INC.22Prior authorization required
Beshp, INC.20No prior authorization
Wellpoint Iowa, INC.22Prior authorization required
Commonwealth Care Alliance, INC.22Prior authorization required
Wellpoint Washington, INC.22Prior authorization required
Neighborhood Health Plan Of Rhode Island22Prior authorization required
Lifeworks Advantage, LLC20No prior authorization
Kansas Superior Select, INC.20No prior authorization
South Country Health Alliance22Prior authorization required
Sentara Health Plans22Prior authorization required
Partners Insurance Company Of New Jersey INC20No prior authorization
Sanford Health Plan Of Minnesota20No prior authorization
Nhc Advantage, LLC20No prior authorization
Vista Health Plan, INC.22Prior authorization required
American Health Plan Of Ut, INC.20No prior authorization
Upmc For You, INC20No prior authorization
American Health Plan Of Missouri, INC.20No prior authorization
Selectcare Of Texas, INC.22Prior authorization required
Troy Health, INC.22Prior authorization required
Banner - University Care Advantage22Prior authorization required
Tufts Health Public Plans, INC.20No prior authorization
Bridgeway Health Solutions Of Arizona, INC.22Prior authorization required
Community Health Plan Of Washington22Prior authorization required
Senior Whole Health Of New York, INC.22Prior authorization required
Nextblue Of North Dakota Insurance Company20No prior authorization
Healthpartners Insurance Company20No prior authorization
Missouri Care, Incorporated22Prior authorization required
Pruitthealth Premier North Carolina, LLC20No prior authorization
American Health Plan Of Iowa INC20No prior authorization
Elderserve Health, INC.22Prior authorization required
Align Senior Care Mi, LLC20No prior authorization
Isnp Ventures, LLC20No prior authorization
Memorial Hermann Health Plan22Prior authorization required
Good Samaritan Insurance Plan Of Nebraska, INC.20No prior authorization
Excellus Health Plan Community Care LLC20No prior authorization
Group Health Cooperative Of Eau Claire22Prior authorization required
Georgia Assurance, INC.20No prior authorization
Caresource Georgia CO.22Prior authorization required
Trinity Health Plan Of Michigan INC22Prior authorization required
Wyoblue Advantage INC20No prior authorization
Community Health Choice Texas, INC.20No prior authorization
Mount Carmel Health Plan Of New York, INC.22Prior authorization required
Align Senior Care Florida, INC.20No prior authorization
Longevity Health Plan Of New Jersey Insurance Comp22Prior authorization required
Hm Health Insurance Company20No prior authorization
Horizon Insurance Company22Prior authorization required
Longevity Health Plan Of Colorado, INC.11Prior authorization required
Local Initiative Health Authority For La County10No prior authorization
Johns Hopkins Health Plan Of Virginia, INC.11Prior authorization required
Longevity Health Plan Of Florida, INC.11Prior authorization required
Community Care Health Plan, INC.10No prior authorization
Alameda Alliance For Health11Prior authorization required
Independent Care Health Plan10No prior authorization
Itasca Medical Care11Prior authorization required
HMO Minnesota11Prior authorization required
Amerihealth Caritas Louisiana, INC.11Prior authorization required
Wellpoint South Carolina, INC.11Prior authorization required
Upper Peninsula Health Plan, LLC11Prior authorization required
Connecticare Insurance Company, INC.11Prior authorization required
Independent Health Benefits Corporation10No prior authorization
Oklahoma Superior Select, INC.10No prior authorization
Provider Partners Health Plan Of Illinois10No prior authorization
Samaritan Health Plans, INC.10No prior authorization
Ghs Health Maintenance Organization, INC.11Prior authorization required
Provider Partners Health Plan Of Texas, INC.10No prior authorization
Hap Caresource11Prior authorization required
Select Health Of South Carolina, INC.11Prior authorization required
Contra Costa County Medical Service Dba Contra Costa Health11Prior authorization required
Paramount Insurance Company11Prior authorization required
Absolute Total Care, INC.11Prior authorization required
Longevity Health Plan Of North Carolina, INC.11Prior authorization required
Orange County Health Authority11Prior authorization required
Health Choice Arizona, INC.11Prior authorization required
Banner Health Plan, INC.11Prior authorization required
Health Plan Of Careoregon, INC.10No prior authorization
Alohacare10No prior authorization
San Mateo Health Commission10No prior authorization
Amerihealth Michigan, INC.11Prior authorization required
Amerihealth Caritas Florida, INC.11Prior authorization required
Caresource Ohio, INC.11Prior authorization required
Lagniappe Advantage Insurance Company10No prior authorization
American Health Plan Of Fl, INC.10No prior authorization
Upmc Health Coverage, INC.10No prior authorization
Provider Partners Health Plan Of Kentucky10No prior authorization
Longevity Health Plan Of Michigan, INC.11Prior authorization required
American Health Plan, INC.10No prior authorization
Amerihealth Caritas North Carolina, INC.11Prior authorization required
Horizon Healthcare Of New Jersey, INC.11Prior authorization required
Longevity Health Plan Of New York, INC.11Prior authorization required
Hawaii Medical Service Association (Hmsa)11Prior authorization required
Dignity Care Corporation10No prior authorization
Healthy Mississippi, INC.11Prior authorization required
Longevity Health Plan Of Illinois, INC.11Prior authorization required
Ventura County Medi-Cal Managed Care Commission11Prior authorization required
Healthfirst Insurance Company, INC.11Prior authorization required
American Health Plan Of Indiana INC10No prior authorization
American Health Plan Of Ms, INC.10No prior authorization
American Health Plan Of Pennsylvania INC10No prior authorization

“Require prior auth” counts a plan when any Cystagon 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.