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Does Medicare Part D cover Emsam?

Emsam appears on the Medicare Part D formularies of 317 payers in the corpus, across 5,496 plans. 153 payers require prior authorization on every covering plan, 1 on some plans, and 163 on none.

Beyond prior authorization: 308 covering plans require step therapy (another drug tried first) and 5,005 apply a quantity limit, on at least one Emsam 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
Humana8178170817Prior authorization required
UnitedHealthcare73100731No prior authorization
Aetna (CVS Health)6586580658Prior authorization required
Devoted Health4154150415Prior authorization required
Blue Cross Blue Shield (affiliate)2691700269Varies by plan
Centene (WellCare)19700197No prior authorization
Cigna17100171No prior authorization
Kaiser Permanente115000No prior authorization
SCAN Health Plan74000No prior authorization
Elevance Health (Anthem)6767067Prior authorization required
Alignment Healthcare6767067Prior authorization required
Medco Containment Life And Medco Containment Ny600060No prior authorization
Molina Healthcare5151051Prior authorization required
Simply Healthcare Plans, INC.5050050Prior authorization required
Cariten Health Plan INC.4444044Prior authorization required
Uhc Of California400040No prior authorization
Priority Health373700Prior authorization required
Careplus Health Plans, INC.3636036Prior authorization required
Bravo Health Pennsylvania, INC.350035No prior authorization
Preferred Care Partners, INC.350035No prior authorization
Zing Health Of Michigan, INC.3333033Prior authorization required
Health Care Service Corporation3131031Prior authorization required
Solis Health Plans, INC.2424024Prior authorization required
Sunshine State Health Plan, INC.240024No prior authorization
Freedom Health, INC.2424024Prior authorization required
Capital Advantage Insurance Company2323023Prior authorization required
Triple S Advantage, INC.22000No prior authorization
Physicians Health Choice Of Texas, LLC220022No prior authorization
Tufts Associated Health Maintenance Organization210210No prior authorization
Mmm Healthcare, LLC200020No prior authorization
Mcs Advantage, INC.2020020Prior authorization required
Harmony Health Plan, INC.190019No prior authorization
Hcsc Insurance Services Company1818018Prior authorization required
California Physicians' Service171700Prior authorization required
Medica Health Plans17000No prior authorization
Upmc Health Plan, INC.17000No prior authorization
Bluecross Blueshield Of Tennessee, INC.170017No prior authorization
Wellpoint Texas, INC.1616016Prior authorization required
Ultimate Health Plans, INC.1601616No prior authorization
Excellus Health Plan, INC.160016No prior authorization
Medical Mutual Of Ohio16000No prior authorization
Superior Healthplan, INC.150015No prior authorization
Florida Blue Medicare, INC.1515015Prior authorization required
Optimum Healthcare, INC.1515015Prior authorization required
Central Health Plan Of California, INC.1515015Prior authorization required
Blue Care Network Of Michigan1515015Prior authorization required
Selecthealth, INC.1401414No prior authorization
Wellpoint Insurance Company1414014Prior authorization required
Peoples Health, INC.130013No prior authorization
Clover Health1313013Prior authorization required
Healthsun Health Plans, INC.1313013Prior authorization required
Prominence Healthfirst Of Texas1301313No prior authorization
Atrio Health Plans1201212No prior authorization
Upmc Health Network, INC.12000No prior authorization
HMO Louisiana, INC.12000No prior authorization
Mount Carmel Health Plan, INC.1111011Prior authorization required
Pacificsource Community Health Plans111100Prior authorization required
Community Insurance Company1010010Prior authorization required
Health Insurance Plan Of Greater New York1010010Prior authorization required
HMO Colorado, INC.1010010Prior authorization required
Quartz Health Plan Corporation1001010No prior authorization
Compcare Health Services Insurance Corporation1010010Prior authorization required
Sanford Health Plan9099No prior authorization
Allina Health And Aetna Insurance Company9909Prior authorization required
Geisinger Health Plan9009No prior authorization
Doctors Healthcare Plans, INC.9909Prior authorization required
New York Quality Healthcare Corporation9009No prior authorization
Wellpoint Tennessee, INC.9909Prior authorization required
Healthier New Jersey Insurance Company8808Prior authorization required
Meridian Health Plan Of Michigan, INC.8008No prior authorization
Healthpartners, INC.8800Prior authorization required
American Progressive Life & Hlth Ins Company Of Ny8008No prior authorization
Mvp Health Plan, INC.8808Prior authorization required
Keystone Health Plan East, INC.8808Prior authorization required
Network Health Insurance Corporation8008No prior authorization
Prominence Healthfirst8088No prior authorization
Fallon Community Health Plan8808Prior authorization required
Peak Health Insurance Corporation8808Prior authorization required
Health Partners Plans, INC.8808Prior authorization required
Medco Containment Life & Medco Containment Ny & Health Care8808Prior authorization required
Viva Health, INC.7707Prior authorization required
Martin'S Point Generations Advantage, INC.7707Prior authorization required
Wellpoint Health Plans, INC.7707Prior authorization required
Astiva Health, INC.7077No prior authorization
Bravo Health Mid-Atlantic, INC.7007No prior authorization
Health Alliance Plan Of Michigan7000No prior authorization
Medica Insurance Company7000No prior authorization
Summacare INC.7077No prior authorization
Keystone Health Plan Central, INC.7707Prior authorization required
Champion Health Plan Of California INC7077No prior authorization
Essence Healthcare PPO, INC.7000No prior authorization
Champion Health Plan Of Nevada, INC.7077No prior authorization
Bluecross And Blueshield Of South Carolina7077No prior authorization
Providence Health Assurance7007No prior authorization
Alterwood Advantage, INC.7077No prior authorization
Mass General Brigham Health Plan, INC6060No prior authorization
Buckeye Community Health Plan, INC.6006No prior authorization
Christus Health Plan6606Prior authorization required
Nebraska Total Care, INC.6006No prior authorization
Gold Kidney Of Florida INC6066No prior authorization
Essence Healthcare, INC.6000No prior authorization
Hometown Health Plan, INC.6066No prior authorization
Presbyterian Health Plan6000No prior authorization
Elderplan, INC.6606Prior authorization required
Perennial Advantage Of Colorado, INC.6606Prior authorization required
Connecticare, INC.6606Prior authorization required
Globalhealth, INC.6066No prior authorization
Preferred Care Network, INC.6006No prior authorization
Scott And White Health Plan6606Prior authorization required
Coordinated Care Of Washington, INC.5005No prior authorization
Chinese Community Health Plan5055No prior authorization
Hopkins Health Advantage, INC.5505Prior authorization required
Alliance Health And Life Insurance Company5000No prior authorization
Sapphire Edge, INC.5505Prior authorization required
Independent Health Association, INC.5000No prior authorization
Coordinated Care Corporation5005No prior authorization
Oh Chs Snp INC.5055No prior authorization
Usable Mutual Insurance Company5505Prior authorization required
Gold Kidney Of Arizona5055No prior authorization
Meridian Health Plan Of Illinois, INC.5005No prior authorization
Sunflower State Health Plan, INC.5005No prior authorization
Prominence Healthfirst Of Florida INC5055No prior authorization
Priority Health Choice, INC.5500Prior authorization required
Arkansas Health & Wellness Health Plan, INC.5005No prior authorization
Hpmp Of Florida, INC.5505Prior authorization required
Home State Health Plan, INC.4004No prior authorization
Baylor Scott & White Insurance Company4404Prior authorization required
Care N' Care Insurance Company Of North Carolina4044No prior authorization
Health New England, INC.4044No prior authorization
Pennsylvania Health & Wellness, INC.4004No prior authorization
The Health Plan Of West Virginia, INC.4000No prior authorization
Communitycare Government Programs, INC.4404Prior authorization required
Hawaii Medical Service Association4404Prior authorization required
Qcc Insurance Company4404Prior authorization required
Leon Health, INC.4044No prior authorization
Verda Health Plan Of Texas INC4044No prior authorization
Security Health Plan Of Wisconsin, INC.4044No prior authorization
Sharp Health Plan4404Prior authorization required
Gateway Health Plan, INC.4004No prior authorization
Capital Health Plan4404Prior authorization required
Boston Medical Center Health Plan, INC.4000No prior authorization
Bluecross Blueshield Kansas Solutions, INC.4404Prior authorization required
Clever Care Of Golden State, INC.4404Prior authorization required
Central Mass Health, LLC4404Prior authorization required
Ghs Insurance Company4404Prior authorization required
Thp Insurance Company4000No prior authorization
Aspire Health Plan4044No prior authorization
Amh Health, LLC4404Prior authorization required
Dean Health Plan, INC.4404Prior authorization required
Quartz Health Plan Mn Corporation4044No prior authorization
Medisun, INC.3033No prior authorization
Metroplus Health Plan, INC.3303Prior authorization required
Wellpoint West Virginia , INC.3303Prior authorization required
Louisiana Health Service & Indemnity Company3000No prior authorization
Eternalhealth, INC.3033No prior authorization
Patrius Health, INC.3303Prior authorization required
Marquis Advantage, INC.3303Prior authorization required
Partners Insurance Company INC3303Prior authorization required
Mount Carmel Health Insurance Company3303Prior authorization required
Community Care Health Plan Of Louisiana, INC.3303Prior authorization required
Village Senior Services Corporation3033No prior authorization
Trillium Community Health Plan, INC.3003No prior authorization
Senior Whole Health, LLC3303Prior authorization required
Baycare Select Health Plans, INC.3033No prior authorization
Cox Health Systems HMO INC3033No prior authorization
Secur INC3303Prior authorization required
Wellpoint New Jersey, INC.3303Prior authorization required
Volunteer State Health Plan3003No prior authorization
Align Senior Care California INC.3303Prior authorization required
Pruitthealth Premier, INC.3303Prior authorization required
Capital District Physicians' Health Plan, INC.3003No prior authorization
Procare Advantage, LLC3303Prior authorization required
Eternalhealth Of Arizona INC3033No prior authorization
Paramount Care, INC.3303Prior authorization required
Aultcare Health Insuring Corporation3000No prior authorization
Mount Carmel Health Plan Of Idaho, INC.3303Prior authorization required
Geisinger Indemnity Insurance Company3003No prior authorization
Simpra Advantage, INC.3303Prior authorization required
Provider Partners Health Plan Of Pennsylvania, INC3033No prior authorization
Provider Partners Health Plan Of North Carolina3033No prior authorization
Provider Partners Health Plan Of Indiana3033No prior authorization
Celtic Insurance Company3003No prior authorization
Amerihealth Insurance Company Of New Jersey3303Prior authorization required
Vns Choice3033No prior authorization
Mercy Care3303Prior authorization required
Usable HMO, INC.3303Prior authorization required
Mclaren Health Plan, INC.3033No prior authorization
Liberty Advantage, LLC3303Prior authorization required
Southeastern Indiana Health Organization, INC.3033No prior authorization
Managed Health Services Insurance CORP.3003No prior authorization
Perennial Advantage Of Ohio, INC.3303Prior authorization required
Provider Partners Health Plan Of Missouri, INC.3033No prior authorization
Hamaspik, INC.2202Prior authorization required
Arizona Physicians Ipa, INC.2002No prior authorization
Ks Plan Administrators, LLC2022No prior authorization
Carepartners Of Connecticut, INC.2020No prior authorization
Amerihealth Caritas Vip Next, INC.2202Prior authorization required
Beshp, INC.2022No prior authorization
Wellpoint Iowa, INC.2202Prior authorization required
Commonwealth Care Alliance, INC.2202Prior authorization required
Arkansas Superior Select, INC.2022No prior authorization
Wellpoint Washington, INC.2202Prior authorization required
Neighborhood Health Plan Of Rhode Island2202Prior authorization required
Lifeworks Advantage, LLC2202Prior authorization required
Kansas Superior Select, INC.2202Prior authorization required
Signature Advantage, LLC2022No prior authorization
Primewest Rural Mn Health Care Access Initiative2022No prior authorization
South Country Health Alliance2200Prior authorization required
Sentara Health Plans2202Prior authorization required
Verda Health Plan Of Arizona, INC.2022No prior authorization
Partners Insurance Company Of New Jersey INC2202Prior authorization required
Sanford Health Plan Of Minnesota2022No prior authorization
Nhc Advantage, LLC2202Prior authorization required
Vista Health Plan, INC.2202Prior authorization required
American Health Plan Of Ut, INC.2202Prior authorization required
Upmc For You, INC2000No prior authorization
American Health Plan Of Missouri, INC.2202Prior authorization required
Selectcare Of Texas, INC.2002No prior authorization
New Century Health Plan, INC.2022No prior authorization
Troy Health, INC.2200Prior authorization required
Community Health Group2022No prior authorization
Banner - University Care Advantage2000No prior authorization
Texas Independence Health Plan, INC.2022No prior authorization
Tufts Health Public Plans, INC.2020No prior authorization
Imperial Health Plan Of California, INC.2022No prior authorization
Bridgeway Health Solutions Of Arizona, INC.2002No prior authorization
Denver Health Medical Plan, INC.2022No prior authorization
Community Health Plan Of Washington2000No prior authorization
Senior Whole Health Of New York, INC.2202Prior authorization required
Nextblue Of North Dakota Insurance Company2202Prior authorization required
Healthpartners Insurance Company2200Prior authorization required
Missouri Care, Incorporated2202Prior authorization required
Pruitthealth Premier North Carolina, LLC2202Prior authorization required
Elite Health Plan, INC.2022No prior authorization
American Health Plan Of Iowa INC2202Prior authorization required
Elderserve Health, INC.2000No prior authorization
Align Senior Care Mi, LLC2202Prior authorization required
Isnp Ventures, LLC2202Prior authorization required
Memorial Hermann Health Plan2202Prior authorization required
Good Samaritan Insurance Plan Of Nebraska, INC.2022No prior authorization
Excellus Health Plan Community Care LLC2002No prior authorization
Group Health Cooperative Of Eau Claire2000No prior authorization
Georgia Assurance, INC.2202Prior authorization required
Caresource Georgia CO.2000No prior authorization
Visiting Nurse Association Of Central New York2022No prior authorization
Trinity Health Plan Of Michigan INC2202Prior authorization required
Wyoblue Advantage INC2202Prior authorization required
Community Health Choice Texas, INC.2202Prior authorization required
Mount Carmel Health Plan Of New York, INC.2202Prior authorization required
Align Senior Care Florida, INC.2202Prior authorization required
Longevity Health Plan Of New Jersey Insurance Comp2000No prior authorization
Hm Health Insurance Company2002No prior authorization
Horizon Insurance Company2202Prior authorization required
Longevity Health Plan Of Colorado, INC.1000No prior authorization
Tsg Guard, INC.1011No prior authorization
Local Initiative Health Authority For La County1101Prior authorization required
Johns Hopkins Health Plan Of Virginia, INC.1101Prior authorization required
Longevity Health Plan Of Florida, INC.1000No prior authorization
Imperial County Local Health Authority1011No prior authorization
Community Care Health Plan, INC.1000No prior authorization
Alameda Alliance For Health1100Prior authorization required
Independent Care Health Plan1101Prior authorization required
Itasca Medical Care1101Prior authorization required
HMO Minnesota1101Prior authorization required
Amerihealth Caritas Louisiana, INC.1101Prior authorization required
Wellpoint South Carolina, INC.1101Prior authorization required
Upper Peninsula Health Plan, LLC1000No prior authorization
Connecticare Insurance Company, INC.1101Prior authorization required
Independent Health Benefits Corporation1000No prior authorization
Oklahoma Superior Select, INC.1101Prior authorization required
Provider Partners Health Plan Of Illinois1011No prior authorization
Allcare Health Plan, INC.1011No prior authorization
Samaritan Health Plans, INC.1011No prior authorization
Ghs Health Maintenance Organization, INC.1101Prior authorization required
Santa Clara County Health Authority1011No prior authorization
Provider Partners Health Plan Of Texas, INC.1011No prior authorization
Kern Health Systems1011No prior authorization
Hap Caresource1000No prior authorization
Select Health Of South Carolina, INC.1101Prior authorization required
Contra Costa County Medical Service Dba Contra Costa Health1100Prior authorization required
Paramount Insurance Company1101Prior authorization required
Absolute Total Care, INC.1001No prior authorization
Longevity Health Plan Of North Carolina, INC.1000No prior authorization
Orange County Health Authority1100Prior authorization required
Health Choice Arizona, INC.1101Prior authorization required
Santa Cruz Monterey Merced San Benito Mariposa Managed Medic1011No prior authorization
San Joaquin County Health Commission1011No prior authorization
Banner Health Plan, INC.1000No prior authorization
Aids Healthcare Foundation1011No prior authorization
Health Plan Of Careoregon, INC.1101Prior authorization required
Alohacare1011No prior authorization
San Mateo Health Commission1001No prior authorization
Amerihealth Michigan, INC.1101Prior authorization required
Amerihealth Caritas Florida, INC.1101Prior authorization required
Caresource Ohio, INC.1000No prior authorization
Lagniappe Advantage Insurance Company1101Prior authorization required
American Health Plan Of Fl, INC.1101Prior authorization required
Upmc Health Coverage, INC.1000No prior authorization
Provider Partners Health Plan Of Kentucky1011No prior authorization
Longevity Health Plan Of Michigan, INC.1000No prior authorization
Santa Barbara San Luis Obispo Regional Health Authority Dba1011No prior authorization
American Health Plan, INC.1101Prior authorization required
San Francisco Health Authority Dba San Francisco Health Plan1011No prior authorization
Amerihealth Caritas North Carolina, INC.1101Prior authorization required
Horizon Healthcare Of New Jersey, INC.1101Prior authorization required
Longevity Health Plan Of New York, INC.1000No prior authorization
Hawaii Medical Service Association (Hmsa)1101Prior authorization required
Dignity Care Corporation1101Prior authorization required
Healthy Mississippi, INC.1011No prior authorization
Inland Empire Health Plan1011No prior authorization
West Virginia Senior Advantage, INC.1011No prior authorization
Longevity Health Plan Of Illinois, INC.1000No prior authorization
Ventura County Medi-Cal Managed Care Commission1101Prior authorization required
Healthfirst Insurance Company, INC.1101Prior authorization required
American Health Plan Of Indiana INC1101Prior authorization required
American Health Plan Of Ms, INC.1101Prior authorization required
American Health Plan Of Pennsylvania INC1101Prior authorization required

“Require prior auth”, “step therapy” and “quantity limit” each count a plan when any Emsam 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.