Benefily
Sign inCreate account

Does Medicare Part D cover Lybalvi?

Lybalvi appears on the Medicare Part D formularies of 190 payers in the corpus, across 2,570 plans. 77 payers require prior authorization on every covering plan, 1 on some plans, and 112 on none.

Beyond prior authorization: 117 covering plans require step therapy (another drug tried first) and 2,414 apply a quantity limit, on at least one Lybalvi 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
Devoted Health41500415No prior authorization
Kaiser Permanente115000No prior authorization
Blue Cross Blue Shield (affiliate)9377093Varies by plan
Alignment Healthcare6767067Prior authorization required
Molina Healthcare510051No prior authorization
Simply Healthcare Plans, INC.5050050Prior authorization required
Cariten Health Plan INC.4444044Prior authorization required
Careplus Health Plans, INC.3636036Prior authorization required
Zing Health Of Michigan, INC.330033No prior authorization
Health Care Service Corporation3131031Prior authorization required
Solis Health Plans, INC.2424024Prior authorization required
Freedom Health, INC.2424024Prior authorization required
Tufts Associated Health Maintenance Organization212100Prior authorization required
Mcs Advantage, INC.2020020Prior authorization required
Hcsc Insurance Services Company1818018Prior authorization required
Ultimate Health Plans, INC.1601616No prior authorization
Excellus Health Plan, INC.1616016Prior authorization required
Florida Blue Medicare, INC.1515015Prior authorization required
Optimum Healthcare, INC.1515015Prior authorization required
Central Health Plan Of California, INC.150015No prior authorization
Selecthealth, INC.1414014Prior authorization required
Clover Health130013No prior authorization
Healthsun Health Plans, INC.1313013Prior authorization required
Prominence Healthfirst Of Texas1313013Prior authorization required
Atrio Health Plans120012No prior authorization
Mount Carmel Health Plan, INC.110011No prior authorization
Pacificsource Community Health Plans1101111No prior authorization
Health Insurance Plan Of Greater New York1010010Prior authorization required
Quartz Health Plan Corporation1001010No prior authorization
Sanford Health Plan9099No prior authorization
Geisinger Health Plan9909Prior authorization required
Doctors Healthcare Plans, INC.9909Prior authorization required
Healthier New Jersey Insurance Company8808Prior authorization required
Healthpartners, INC.8808Prior authorization required
Mvp Health Plan, INC.8008No prior authorization
Keystone Health Plan East, INC.8808Prior authorization required
Network Health Insurance Corporation8008No prior authorization
Prominence Healthfirst8808Prior authorization required
Fallon Community Health Plan8088No prior authorization
Medco Containment Life & Medco Containment Ny & Health Care8808Prior authorization required
Viva Health, INC.7007No prior authorization
Martin'S Point Generations Advantage, INC.7007No prior authorization
Aetna (CVS Health)7007No prior authorization
Astiva Health, INC.7007No prior authorization
Health Alliance Plan Of Michigan7707Prior authorization required
Summacare INC.7007No prior authorization
Champion Health Plan Of California INC7007No prior authorization
Champion Health Plan Of Nevada, INC.7007No prior authorization
Bluecross And Blueshield Of South Carolina7077No prior authorization
Providence Health Assurance7707Prior authorization required
Alterwood Advantage, INC.7007No prior authorization
Mass General Brigham Health Plan, INC6606Prior authorization required
Christus Health Plan6006No prior authorization
Gold Kidney Of Florida INC6006No prior authorization
Hometown Health Plan, INC.6066No prior authorization
Presbyterian Health Plan6606Prior authorization required
Elderplan, INC.6006No prior authorization
Connecticare, INC.6006No prior authorization
Globalhealth, INC.6006No prior authorization
Scott And White Health Plan6606Prior authorization required
Chinese Community Health Plan5005No prior authorization
Hopkins Health Advantage, INC.5005No prior authorization
Alliance Health And Life Insurance Company5505Prior authorization required
Sapphire Edge, INC.5505Prior authorization required
Independent Health Association, INC.5500Prior authorization required
Oh Chs Snp INC.5005No prior authorization
Usable Mutual Insurance Company5005No prior authorization
Gold Kidney Of Arizona5005No prior authorization
Prominence Healthfirst Of Florida INC5505Prior authorization required
Hpmp Of Florida, INC.5005No 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
Hawaii Medical Service Association4004No prior authorization
Qcc Insurance Company4404Prior authorization required
Leon Health, INC.4004No prior authorization
Verda Health Plan Of Texas INC4004No prior authorization
Security Health Plan Of Wisconsin, INC.4044No prior authorization
Sharp Health Plan4004No prior authorization
Gateway Health Plan, INC.4404Prior authorization required
Capital Health Plan4404Prior authorization required
Bluecross Blueshield Kansas Solutions, INC.4404Prior authorization required
Clever Care Of Golden State, INC.4004No prior authorization
Central Mass Health, LLC4404Prior authorization required
Ghs Insurance Company4404Prior authorization required
Aspire Health Plan4004No prior authorization
Quartz Health Plan Mn Corporation4044No prior authorization
Medisun, INC.3033No prior authorization
Metroplus Health Plan, INC.3003No prior authorization
Eternalhealth, INC.3033No prior authorization
Patrius Health, INC.3303Prior authorization required
Mount Carmel Health Insurance Company3003No prior authorization
Village Senior Services Corporation3003No prior authorization
Senior Whole Health, LLC3003No prior authorization
Baycare Select Health Plans, INC.3003No prior authorization
Cox Health Systems HMO INC3003No prior authorization
Capital District Physicians' Health Plan, INC.3303Prior authorization required
Eternalhealth Of Arizona INC3033No prior authorization
Paramount Care, INC.3003No prior authorization
Aultcare Health Insuring Corporation3000No prior authorization
Mount Carmel Health Plan Of Idaho, INC.3003No prior authorization
Geisinger Indemnity Insurance Company3303Prior 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
Amerihealth Insurance Company Of New Jersey3303Prior authorization required
Vns Choice3003No prior authorization
Mercy Care3003No prior authorization
Usable HMO, INC.3003No prior authorization
Mclaren Health Plan, INC.3003No prior authorization
Southeastern Indiana Health Organization, INC.3003No prior authorization
Provider Partners Health Plan Of Missouri, INC.3033No prior authorization
Hamaspik, INC.2202Prior authorization required
Ks Plan Administrators, LLC2022No prior authorization
Carepartners Of Connecticut, INC.2200Prior authorization required
Amerihealth Caritas Vip Next, INC.2202Prior authorization required
Beshp, INC.2022No prior authorization
Commonwealth Care Alliance, INC.2002No prior authorization
Arkansas Superior Select, INC.2002No prior authorization
Neighborhood Health Plan Of Rhode Island2002No prior authorization
Signature Advantage, LLC2002No prior authorization
Primewest Rural Mn Health Care Access Initiative2002No prior authorization
South Country Health Alliance2200Prior authorization required
Sentara Health Plans2202Prior authorization required
Verda Health Plan Of Arizona, INC.2002No prior authorization
Sanford Health Plan Of Minnesota2022No prior authorization
Capital Advantage Insurance Company2202Prior authorization required
Keystone Health Plan Central, INC.2202Prior authorization required
Vista Health Plan, INC.2202Prior authorization required
New Century Health Plan, INC.2002No prior authorization
Troy Health, INC.2200Prior authorization required
Community Health Group2002No prior authorization
Texas Independence Health Plan, INC.2002No prior authorization
Tufts Health Public Plans, INC.2200Prior authorization required
Imperial Health Plan Of California, INC.2002No prior authorization
Denver Health Medical Plan, INC.2002No prior authorization
Senior Whole Health Of New York, INC.2002No prior authorization
Healthpartners Insurance Company2202Prior authorization required
Elite Health Plan, INC.2002No prior authorization
Memorial Hermann Health Plan2202Prior authorization required
Good Samaritan Insurance Plan Of Nebraska, INC.2022No prior authorization
Excellus Health Plan Community Care LLC2202Prior authorization required
Visiting Nurse Association Of Central New York2002No prior authorization
Trinity Health Plan Of Michigan INC2002No prior authorization
Mount Carmel Health Plan Of New York, INC.2002No prior authorization
Elevance Health (Anthem)2002No prior authorization
Horizon Insurance Company2202Prior authorization required
Tsg Guard, INC.1001No prior authorization
Johns Hopkins Health Plan Of Virginia, INC.1001No prior authorization
Imperial County Local Health Authority1001No prior authorization
Community Care Health Plan, INC.1000No prior authorization
Alameda Alliance For Health1100Prior authorization required
Independent Care Health Plan1101Prior authorization required
Itasca Medical Care1001No prior authorization
HMO Minnesota1101Prior authorization required
Amerihealth Caritas Louisiana, INC.1101Prior authorization required
Connecticare Insurance Company, INC.1001No prior authorization
Independent Health Benefits Corporation1100Prior authorization required
Provider Partners Health Plan Of Illinois1011No prior authorization
Allcare Health Plan, INC.1001No prior authorization
Samaritan Health Plans, INC.1011No prior authorization
Ghs Health Maintenance Organization, INC.1101Prior authorization required
Santa Clara County Health Authority1001No prior authorization
Provider Partners Health Plan Of Texas, INC.1011No prior authorization
Kern Health Systems1001No prior authorization
Select Health Of South Carolina, INC.1101Prior authorization required
Contra Costa County Medical Service Dba Contra Costa Health1100Prior authorization required
Paramount Insurance Company1001No prior authorization
Orange County Health Authority1101Prior authorization required
Health Choice Arizona, INC.1001No prior authorization
Santa Cruz Monterey Merced San Benito Mariposa Managed Medic1001No prior authorization
San Joaquin County Health Commission1001No prior authorization
Aids Healthcare Foundation1001No prior authorization
Health Plan Of Careoregon, INC.1101Prior authorization required
Alohacare1011No prior authorization
San Mateo Health Commission1101Prior authorization required
Amerihealth Michigan, INC.1101Prior authorization required
Amerihealth Caritas Florida, INC.1101Prior authorization required
Provider Partners Health Plan Of Kentucky1011No prior authorization
Santa Barbara San Luis Obispo Regional Health Authority Dba1001No prior authorization
San Francisco Health Authority Dba San Francisco Health Plan1001No prior authorization
Amerihealth Caritas North Carolina, INC.1101Prior authorization required
Horizon Healthcare Of New Jersey, INC.1101Prior authorization required
Hawaii Medical Service Association (Hmsa)1001No prior authorization
Healthy Mississippi, INC.1101Prior authorization required
Inland Empire Health Plan1101Prior authorization required
West Virginia Senior Advantage, INC.1001No prior authorization
Ventura County Medi-Cal Managed Care Commission1101Prior authorization required
Healthfirst Insurance Company, INC.1001No prior authorization

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