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Does Medicare Part D cover Lyllana?

Lyllana appears on the Medicare Part D formularies of 186 payers in the corpus, across 3,426 plans. 4 payers require prior authorization on every covering plan, 2 on some plans, and 180 on none.

Beyond prior authorization: 0 covering plans require step therapy (another drug tried first) and 2,176 apply a quantity limit, on at least one Lyllana 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
Humana81700817No prior authorization
Aetna (CVS Health)65300636No prior authorization
Devoted Health415000No prior authorization
Centene (WellCare)19700197No prior authorization
Blue Cross Blue Shield (affiliate)106606Varies by plan
SCAN Health Plan74000No prior authorization
Alignment Healthcare67000No prior authorization
Molina Healthcare51000No prior authorization
Cariten Health Plan INC.440044No prior authorization
Priority Health37000No prior authorization
Careplus Health Plans, INC.360036No prior authorization
Zing Health Of Michigan, INC.33000No prior authorization
Health Care Service Corporation31000No prior authorization
Solis Health Plans, INC.24000No prior authorization
Sunshine State Health Plan, INC.240024No prior authorization
Harmony Health Plan, INC.190019No prior authorization
Hcsc Insurance Services Company18000No prior authorization
California Physicians' Service170017No prior authorization
Medica Health Plans170017No prior authorization
Upmc Health Plan, INC.170017No prior authorization
Bluecross Blueshield Of Tennessee, INC.170017No prior authorization
Ultimate Health Plans, INC.16000No prior authorization
Medical Mutual Of Ohio160016No prior authorization
Superior Healthplan, INC.150015No prior authorization
Elevance Health (Anthem)1513013Varies by plan
Central Health Plan Of California, INC.15000No prior authorization
Selecthealth, INC.14000No prior authorization
Florida Blue Medicare, INC.13000No prior authorization
Clover Health13000No prior authorization
Prominence Healthfirst Of Texas130013No prior authorization
Upmc Health Network, INC.120012No prior authorization
HMO Louisiana, INC.120012No prior authorization
Mount Carmel Health Plan, INC.11000No prior authorization
Pacificsource Community Health Plans11000No prior authorization
Health Insurance Plan Of Greater New York10000No prior authorization
Quartz Health Plan Corporation10000No prior authorization
Sanford Health Plan9000No prior authorization
Allina Health And Aetna Insurance Company9009No prior authorization
New York Quality Healthcare Corporation9009No prior authorization
Healthier New Jersey Insurance Company8000No prior authorization
Meridian Health Plan Of Michigan, INC.8008No prior authorization
American Progressive Life & Hlth Ins Company Of Ny8008No prior authorization
Mvp Health Plan, INC.8000No prior authorization
Network Health Insurance Corporation8000No prior authorization
Prominence Healthfirst8008No prior authorization
Fallon Community Health Plan8008No prior authorization
Medco Containment Life & Medco Containment Ny & Health Care8000No prior authorization
Viva Health, INC.7000No prior authorization
Martin'S Point Generations Advantage, INC.7000No prior authorization
Health Alliance Plan Of Michigan7007No prior authorization
Medica Insurance Company7007No prior authorization
Summacare INC.7007No prior authorization
Essence Healthcare PPO, INC.7007No prior authorization
Bluecross And Blueshield Of South Carolina7000No prior authorization
Providence Health Assurance7007No prior authorization
Mass General Brigham Health Plan, INC6000No prior authorization
Buckeye Community Health Plan, INC.6006No prior authorization
Christus Health Plan6000No prior authorization
Nebraska Total Care, INC.6006No prior authorization
Gold Kidney Of Florida INC6006No prior authorization
Essence Healthcare, INC.6006No prior authorization
Hometown Health Plan, INC.6000No prior authorization
Presbyterian Health Plan6600Prior authorization required
Elderplan, INC.6000No prior authorization
Connecticare, INC.6000No prior authorization
Scott And White Health Plan6000No prior authorization
Coordinated Care Of Washington, INC.5005No prior authorization
Hopkins Health Advantage, INC.5000No prior authorization
Alliance Health And Life Insurance Company5005No prior authorization
Sapphire Edge, INC.5000No prior authorization
Independent Health Association, INC.5005No prior authorization
Coordinated Care Corporation5005No prior authorization
Usable Mutual Insurance Company5000No prior authorization
Gold Kidney Of Arizona5005No prior authorization
Meridian Health Plan Of Illinois, INC.5005No prior authorization
Sunflower State Health Plan, INC.5005No prior authorization
Prominence Healthfirst Of Florida INC5005No prior authorization
Priority Health Choice, INC.5000No prior authorization
Arkansas Health & Wellness Health Plan, INC.5005No prior authorization
Hpmp Of Florida, INC.5000No prior authorization
Home State Health Plan, INC.4004No prior authorization
Baylor Scott & White Insurance Company4000No prior authorization
Care N' Care Insurance Company Of North Carolina4000No prior authorization
Health New England, INC.4004No prior authorization
Pennsylvania Health & Wellness, INC.4004No prior authorization
The Health Plan Of West Virginia, INC.4004No prior authorization
Hawaii Medical Service Association4000No prior authorization
Security Health Plan Of Wisconsin, INC.4000No prior authorization
Sharp Health Plan4000No prior authorization
Wellpoint Tennessee, INC.4404Prior authorization required
Capital Health Plan4000No prior authorization
Boston Medical Center Health Plan, INC.4004No prior authorization
Bluecross Blueshield Kansas Solutions, INC.4000No prior authorization
Clever Care Of Golden State, INC.4000No prior authorization
Central Mass Health, LLC4000No prior authorization
Ghs Insurance Company4000No prior authorization
Thp Insurance Company4004No prior authorization
Health Partners Plans, INC.4004No prior authorization
Quartz Health Plan Mn Corporation4000No prior authorization
Medisun, INC.3000No prior authorization
Metroplus Health Plan, INC.3000No prior authorization
Louisiana Health Service & Indemnity Company3003No prior authorization
Eternalhealth, INC.3000No prior authorization
Patrius Health, INC.3000No prior authorization
Mount Carmel Health Insurance Company3000No prior authorization
Trillium Community Health Plan, INC.3003No prior authorization
Senior Whole Health, LLC3000No prior authorization
Volunteer State Health Plan3003No prior authorization
Eternalhealth Of Arizona INC3000No prior authorization
Paramount Care, INC.3000No prior authorization
Aultcare Health Insuring Corporation3000No prior authorization
Mount Carmel Health Plan Of Idaho, INC.3000No prior authorization
Provider Partners Health Plan Of Pennsylvania, INC3000No prior authorization
Provider Partners Health Plan Of North Carolina3000No prior authorization
Provider Partners Health Plan Of Indiana3000No prior authorization
Celtic Insurance Company3003No prior authorization
Mercy Care3000No prior authorization
Usable HMO, INC.3000No prior authorization
Managed Health Services Insurance CORP.3003No prior authorization
Provider Partners Health Plan Of Missouri, INC.3000No prior authorization
Hamaspik, INC.2000No prior authorization
Ks Plan Administrators, LLC2000No prior authorization
Beshp, INC.2000No prior authorization
Commonwealth Care Alliance, INC.2000No prior authorization
Partners Insurance Company INC2002No prior authorization
Neighborhood Health Plan Of Rhode Island2000No prior authorization
Village Senior Services Corporation2002No prior authorization
Sentara Health Plans2002No prior authorization
Sanford Health Plan Of Minnesota2000No prior authorization
Capital Advantage Insurance Company2000No prior authorization
Keystone Health Plan Central, INC.2000No prior authorization
Upmc For You, INC2002No prior authorization
Selectcare Of Texas, INC.2002No prior authorization
Banner - University Care Advantage2002No prior authorization
Vns Choice2002No prior authorization
Bridgeway Health Solutions Of Arizona, INC.2002No prior authorization
Community Health Plan Of Washington2002No prior authorization
Senior Whole Health Of New York, INC.2000No prior authorization
Elderserve Health, INC.2002No prior authorization
Memorial Hermann Health Plan2000No prior authorization
Good Samaritan Insurance Plan Of Nebraska, INC.2000No prior authorization
Group Health Cooperative Of Eau Claire2002No prior authorization
Caresource Georgia CO.2002No prior authorization
Trinity Health Plan Of Michigan INC2000No prior authorization
Mount Carmel Health Plan Of New York, INC.2000No prior authorization
Longevity Health Plan Of New Jersey Insurance Comp2002No prior authorization
Hm Health Insurance Company2000No prior authorization
Horizon Insurance Company2000No prior authorization
Longevity Health Plan Of Colorado, INC.1001No prior authorization
Wellpoint West Virginia , INC.1101Prior authorization required
Johns Hopkins Health Plan Of Virginia, INC.1000No prior authorization
Longevity Health Plan Of Florida, INC.1001No prior authorization
Independent Care Health Plan1001No prior authorization
Itasca Medical Care1000No prior authorization
HMO Minnesota1000No prior authorization
Wellpoint South Carolina, INC.1101Prior authorization required
Partners Insurance Company Of New Jersey INC1001No prior authorization
Upper Peninsula Health Plan, LLC1001No prior authorization
Connecticare Insurance Company, INC.1000No prior authorization
Independent Health Benefits Corporation1001No prior authorization
Provider Partners Health Plan Of Illinois1000No prior authorization
Samaritan Health Plans, INC.1000No prior authorization
Ghs Health Maintenance Organization, INC.1000No prior authorization
Provider Partners Health Plan Of Texas, INC.1000No prior authorization
Hap Caresource1001No prior authorization
Paramount Insurance Company1000No prior authorization
Absolute Total Care, INC.1001No prior authorization
Longevity Health Plan Of North Carolina, INC.1001No prior authorization
Orange County Health Authority1001No prior authorization
Health Choice Arizona, INC.1000No prior authorization
Banner Health Plan, INC.1001No prior authorization
Aids Healthcare Foundation1001No prior authorization
Health Plan Of Careoregon, INC.1001No prior authorization
Alohacare1000No prior authorization
San Mateo Health Commission1001No prior authorization
Caresource Ohio, INC.1001No prior authorization
Upmc Health Coverage, INC.1001No prior authorization
Provider Partners Health Plan Of Kentucky1000No prior authorization
Longevity Health Plan Of Michigan, INC.1001No prior authorization
Horizon Healthcare Of New Jersey, INC.1000No prior authorization
Longevity Health Plan Of New York, INC.1001No prior authorization
Hawaii Medical Service Association (Hmsa)1000No prior authorization
Healthy Mississippi, INC.1000No prior authorization
Longevity Health Plan Of Illinois, INC.1001No prior authorization
Ventura County Medi-Cal Managed Care Commission1000No prior authorization
Healthfirst Insurance Company, INC.1000No prior authorization

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