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Does Medicare Part D cover Fetzima?

Fetzima appears on the Medicare Part D formularies of 317 payers in the corpus, across 5,496 plans. 120 payers require prior authorization on every covering plan, 2 on some plans, and 195 on none.

Beyond prior authorization: 1,586 covering plans require step therapy (another drug tried first) and 5,237 apply a quantity limit, on at least one Fetzima 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
UnitedHealthcare7310731731No prior authorization
Aetna (CVS Health)6586580658Prior authorization required
Devoted Health4154150415Prior authorization required
Blue Cross Blue Shield (affiliate)2691950269Varies by plan
Centene (WellCare)19700197No prior authorization
Cigna1710171171No prior authorization
Kaiser Permanente115000No prior authorization
SCAN Health Plan74000No prior authorization
Elevance Health (Anthem)6767067Prior authorization required
Alignment Healthcare670067No prior authorization
Medco Containment Life And Medco Containment Ny6006060No prior authorization
Molina Healthcare5151051Prior authorization required
Simply Healthcare Plans, INC.5050050Prior authorization required
Cariten Health Plan INC.4444044Prior authorization required
Uhc Of California4004040No prior authorization
Priority Health3703737No prior authorization
Careplus Health Plans, INC.3636036Prior authorization required
Bravo Health Pennsylvania, INC.3503535No prior authorization
Preferred Care Partners, INC.3503535No prior authorization
Zing Health Of Michigan, INC.3333033Prior authorization required
Health Care Service Corporation310031No prior authorization
Solis Health Plans, INC.240024No prior authorization
Sunshine State Health Plan, INC.240024No prior authorization
Freedom Health, INC.2424024Prior authorization required
Capital Advantage Insurance Company230023No prior authorization
Triple S Advantage, INC.2202222No prior authorization
Physicians Health Choice Of Texas, LLC2202222No prior authorization
Tufts Associated Health Maintenance Organization210210No prior authorization
Mmm Healthcare, LLC2002020No prior authorization
Mcs Advantage, INC.2002020No prior authorization
Harmony Health Plan, INC.190019No prior authorization
Hcsc Insurance Services Company180018No prior authorization
California Physicians' Service1717017Prior authorization required
Medica Health Plans170017No prior authorization
Upmc Health Plan, INC.1717017Prior authorization required
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 Ohio160016No prior authorization
Superior Healthplan, INC.150015No prior authorization
Florida Blue Medicare, INC.152015Varies by plan
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.1301313No 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.1212012Prior authorization required
HMO Louisiana, INC.120012No prior authorization
Mount Carmel Health Plan, INC.1111011Prior authorization required
Pacificsource Community Health Plans11000No prior authorization
Community Insurance Company1010010Prior authorization required
Health Insurance Plan Of Greater New York100010No prior authorization
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 Plan9909Prior authorization required
Doctors Healthcare Plans, INC.9099No prior authorization
New York Quality Healthcare Corporation9009No prior authorization
Wellpoint Tennessee, INC.9909Prior authorization required
Healthier New Jersey Insurance Company8008No prior authorization
Meridian Health Plan Of Michigan, INC.8008No prior authorization
Healthpartners, INC.8808Prior authorization required
American Progressive Life & Hlth Ins Company Of Ny8008No prior authorization
Mvp Health Plan, INC.8808Prior authorization required
Keystone Health Plan East, INC.8080No prior authorization
Network Health Insurance Corporation8000No 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 Care8008No prior authorization
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.7077No prior authorization
Health Alliance Plan Of Michigan7707Prior authorization required
Medica Insurance Company7007No prior authorization
Summacare INC.7077No prior authorization
Keystone Health Plan Central, INC.7007No prior authorization
Champion Health Plan Of California INC7077No prior authorization
Essence Healthcare PPO, INC.7007No prior authorization
Champion Health Plan Of Nevada, INC.7077No prior authorization
Bluecross And Blueshield Of South Carolina7077No prior authorization
Providence Health Assurance7077No 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.6006No prior authorization
Hometown Health Plan, INC.6066No prior authorization
Presbyterian Health Plan6066No 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.6066No prior authorization
Scott And White Health Plan6006No prior authorization
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 Company5505Prior authorization required
Sapphire Edge, INC.5005No prior authorization
Independent Health Association, INC.5005No 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.5055No prior authorization
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 Company4004No prior authorization
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.4004No prior authorization
Communitycare Government Programs, INC.4404Prior authorization required
Hawaii Medical Service Association4404Prior authorization required
Qcc Insurance Company4040No prior authorization
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.4404Prior authorization required
Capital Health Plan4004No prior authorization
Boston Medical Center Health Plan, INC.4004No prior authorization
Bluecross Blueshield Kansas Solutions, INC.4004No prior authorization
Clever Care Of Golden State, INC.4404Prior authorization required
Central Mass Health, LLC4004No prior authorization
Ghs Insurance Company4004No prior authorization
Thp Insurance Company4004No 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 Company3003No prior authorization
Eternalhealth, INC.3033No prior authorization
Patrius Health, INC.3003No prior authorization
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 Company3303Prior authorization required
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 Jersey3030No prior authorization
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.2002No prior authorization
Arizona Physicians Ipa, INC.2022No prior authorization
Ks Plan Administrators, LLC2022No prior authorization
Carepartners Of Connecticut, INC.2020No prior authorization
Amerihealth Caritas Vip Next, INC.2022No prior authorization
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 Alliance2022No prior authorization
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.2022No prior authorization
American Health Plan Of Ut, INC.2202Prior authorization required
Upmc For You, INC2202Prior authorization required
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.2022No prior authorization
Community Health Group2022No prior authorization
Banner - University Care Advantage2002No 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 Washington2002No prior authorization
Senior Whole Health Of New York, INC.2202Prior authorization required
Nextblue Of North Dakota Insurance Company2202Prior authorization required
Healthpartners Insurance Company2202Prior 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.2002No prior authorization
Align Senior Care Mi, LLC2202Prior authorization required
Isnp Ventures, LLC2202Prior authorization required
Memorial Hermann Health Plan2002No prior authorization
Good Samaritan Insurance Plan Of Nebraska, INC.2022No prior authorization
Excellus Health Plan Community Care LLC2002No prior authorization
Group Health Cooperative Of Eau Claire2002No prior authorization
Georgia Assurance, INC.2202Prior authorization required
Caresource Georgia CO.2002No 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 Comp2002No prior authorization
Hm Health Insurance Company2202Prior authorization required
Horizon Insurance Company2002No prior authorization
Longevity Health Plan Of Colorado, INC.1001No 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.1001No prior authorization
Imperial County Local Health Authority1011No prior authorization
Community Care Health Plan, INC.1000No prior authorization
Alameda Alliance For Health1011No prior authorization
Independent Care Health Plan1101Prior authorization required
Itasca Medical Care1101Prior authorization required
HMO Minnesota1001No prior authorization
Amerihealth Caritas Louisiana, INC.1011No prior authorization
Wellpoint South Carolina, INC.1101Prior authorization required
Upper Peninsula Health Plan, LLC1001No prior authorization
Connecticare Insurance Company, INC.1101Prior authorization required
Independent Health Benefits Corporation1001No 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.1001No prior authorization
Santa Clara County Health Authority1011No prior authorization
Provider Partners Health Plan Of Texas, INC.1011No prior authorization
Kern Health Systems1011No prior authorization
Hap Caresource1001No prior authorization
Select Health Of South Carolina, INC.1011No prior authorization
Contra Costa County Medical Service Dba Contra Costa Health1011No prior authorization
Paramount Insurance Company1101Prior authorization required
Absolute Total Care, INC.1001No prior authorization
Longevity Health Plan Of North Carolina, INC.1001No prior authorization
Orange County Health Authority1101Prior 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.1001No prior authorization
Aids Healthcare Foundation1011No prior authorization
Health Plan Of Careoregon, INC.1101Prior authorization required
Alohacare1011No prior authorization
San Mateo Health Commission1100Prior authorization required
Amerihealth Michigan, INC.1011No prior authorization
Amerihealth Caritas Florida, INC.1011No prior authorization
Caresource Ohio, INC.1001No prior authorization
Lagniappe Advantage Insurance Company1101Prior authorization required
American Health Plan Of Fl, INC.1101Prior authorization required
Upmc Health Coverage, INC.1101Prior authorization required
Provider Partners Health Plan Of Kentucky1011No prior authorization
Longevity Health Plan Of Michigan, INC.1001No 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.1011No prior authorization
Horizon Healthcare Of New Jersey, INC.1001No prior authorization
Longevity Health Plan Of New York, INC.1001No 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.1001No prior authorization
Ventura County Medi-Cal Managed Care Commission1001No prior authorization
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 Fetzima 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.