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Does Medicare Part D cover Nivestym?

Nivestym appears on the Medicare Part D formularies of 198 payers in the corpus. 152 require prior authorization on every covering plan, 1 on some plans, and 45 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
Humana817817Prior authorization required
Centene (WellCare)197197Prior authorization required
Cigna171171Prior authorization required
Blue Cross Blue Shield (affiliate)16973Varies by plan
Kaiser Permanente1150No prior authorization
SCAN Health Plan7474Prior authorization required
Alignment Healthcare6767Prior authorization required
Medco Containment Life And Medco Containment Ny6060Prior authorization required
Elevance Health (Anthem)5151Prior authorization required
Cariten Health Plan INC.4444Prior authorization required
Priority Health3737Prior authorization required
Careplus Health Plans, INC.3636Prior authorization required
Bravo Health Pennsylvania, INC.3535Prior 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
Mmm Healthcare, LLC2020Prior authorization required
Health Care Service Corporation1919Prior authorization required
Harmony Health Plan, INC.1919Prior authorization required
California Physicians' Service1717Prior authorization required
Medica Health Plans1717Prior authorization required
Medical Mutual Of Ohio1616Prior authorization required
Superior Healthplan, INC.1515Prior authorization required
Optimum Healthcare, INC.1515Prior authorization required
Selecthealth, INC.1414Prior authorization required
Prominence Healthfirst Of Texas1313Prior authorization required
Atrio Health Plans1212Prior authorization required
HMO Louisiana, INC.1212Prior authorization required
Hcsc Insurance Services Company1111Prior authorization required
Wellpoint Texas, INC.1111Prior authorization required
Pacificsource Community Health Plans1111Prior authorization required
Wellpoint Insurance Company1111Prior authorization required
Community Insurance Company1010Prior authorization required
Compcare Health Services Insurance Corporation1010Prior authorization required
Geisinger Health Plan99Prior authorization required
Doctors Healthcare Plans, INC.99Prior authorization required
New York Quality Healthcare Corporation99Prior 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
Keystone Health Plan East, INC.80No prior authorization
Prominence Healthfirst88Prior authorization required
Peak Health Insurance Corporation80No prior authorization
Astiva Health, INC.77Prior authorization required
Bravo Health Mid-Atlantic, INC.77Prior authorization required
Medica Insurance Company77Prior authorization required
Summacare INC.77Prior authorization required
Keystone Health Plan Central, INC.77Prior authorization required
Champion Health Plan Of California INC77Prior authorization required
Essence Healthcare PPO, INC.77Prior authorization required
Champion Health Plan Of Nevada, INC.77Prior authorization required
Providence Health Assurance70No prior authorization
Alterwood Advantage, INC.77Prior authorization required
Buckeye Community Health Plan, INC.66Prior authorization required
Nebraska Total Care, INC.66Prior authorization required
Gold Kidney Of Florida INC66Prior authorization required
Essence Healthcare, INC.66Prior authorization required
Perennial Advantage Of Colorado, INC.60No prior authorization
Globalhealth, INC.66Prior authorization required
Scott And White Health Plan66Prior authorization required
Coordinated Care Of Washington, INC.55Prior authorization required
Chinese Community Health Plan55Prior authorization required
Aetna (CVS Health)50No prior authorization
Coordinated Care Corporation55Prior authorization required
Oh Chs Snp INC.55Prior authorization required
HMO Colorado, INC.55Prior authorization required
Gold Kidney Of Arizona55Prior authorization required
Meridian Health Plan Of Illinois, INC.55Prior authorization required
Wellpoint Tennessee, INC.55Prior authorization required
Sunflower State Health Plan, INC.55Prior authorization required
Prominence Healthfirst Of Florida INC55Prior authorization required
Priority Health Choice, INC.55Prior authorization required
Arkansas Health & Wellness Health Plan, INC.55Prior authorization required
Home State Health Plan, INC.44Prior authorization required
Baylor Scott & White Insurance Company44Prior authorization required
Pennsylvania Health & Wellness, INC.44Prior authorization required
Sapphire Edge, INC.44Prior authorization required
The Health Plan Of West Virginia, INC.44Prior authorization required
Communitycare Government Programs, INC.40No prior authorization
Qcc Insurance Company40No prior authorization
Leon Health, INC.44Prior authorization required
Verda Health Plan Of Texas INC44Prior authorization required
Boston Medical Center Health Plan, INC.44Prior authorization required
Bluecross Blueshield Kansas Solutions, INC.44Prior authorization required
Thp Insurance Company44Prior authorization required
Aspire Health Plan44Prior authorization required
Amh Health, LLC44Prior authorization required
Dean Health Plan, INC.40No prior authorization
Louisiana Health Service & Indemnity Company33Prior authorization required
Marquis Advantage, INC.30No prior authorization
Community Care Health Plan Of Louisiana, INC.33Prior authorization required
Village Senior Services Corporation33Prior authorization required
Trillium Community Health Plan, INC.33Prior authorization required
Baycare Select Health Plans, INC.33Prior authorization required
Cox Health Systems HMO INC33Prior authorization required
Secur INC30No prior authorization
Wellpoint New Jersey, INC.33Prior authorization required
Align Senior Care California INC.30No prior authorization
Pruitthealth Premier, INC.30No prior authorization
Procare Advantage, LLC30No prior authorization
Aultcare Health Insuring Corporation30No prior authorization
Geisinger Indemnity Insurance Company33Prior authorization required
Simpra Advantage, INC.30No prior authorization
Celtic Insurance Company33Prior authorization required
Amerihealth Insurance Company Of New Jersey30No prior authorization
Vns Choice33Prior authorization required
Mclaren Health Plan, INC.33Prior authorization required
Liberty Advantage, LLC30No prior authorization
Southeastern Indiana Health Organization, INC.33Prior authorization required
Central Mass Health, LLC33Prior authorization required
Ghs Insurance Company33Prior authorization required
Managed Health Services Insurance CORP.33Prior authorization required
Perennial Advantage Of Ohio, INC.30No prior authorization
Medco Containment Life & Medco Containment Ny & Health Care33Prior authorization required
Hamaspik, INC.22Prior authorization required
Wellpoint Iowa, INC.22Prior authorization required
Florida Blue Medicare, INC.20No prior authorization
Wellpoint West Virginia , INC.22Prior authorization required
Arkansas Superior Select, INC.22Prior authorization required
Wellpoint Washington, INC.22Prior authorization required
Lifeworks Advantage, LLC20No prior authorization
Kansas Superior Select, INC.20No prior authorization
Signature Advantage, LLC22Prior authorization required
Primewest Rural Mn Health Care Access Initiative22Prior authorization required
Sentara Health Plans22Prior authorization required
Verda Health Plan Of Arizona, INC.22Prior authorization required
Nhc Advantage, LLC20No prior authorization
American Health Plan Of Ut, INC.20No prior authorization
American Health Plan Of Missouri, INC.20No prior authorization
Selectcare Of Texas, INC.22Prior authorization required
New Century Health Plan, INC.22Prior authorization required
Community Health Group22Prior authorization required
Banner - University Care Advantage22Prior authorization required
Texas Independence Health Plan, INC.22Prior authorization required
Imperial Health Plan Of California, INC.22Prior authorization required
Bridgeway Health Solutions Of Arizona, INC.22Prior authorization required
Denver Health Medical Plan, INC.22Prior authorization required
Community Health Plan Of Washington22Prior authorization required
Capital Health Plan22Prior authorization required
Healthpartners Insurance Company20No prior authorization
Missouri Care, Incorporated22Prior authorization required
Pruitthealth Premier North Carolina, LLC20No prior authorization
Elite Health Plan, INC.22Prior authorization required
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
Group Health Cooperative Of Eau Claire22Prior authorization required
Georgia Assurance, INC.20No prior authorization
Caresource Georgia CO.22Prior authorization required
Visiting Nurse Association Of Central New York22Prior authorization required
Community Health Choice Texas, INC.20No prior authorization
Align Senior Care Florida, INC.20No prior authorization
Longevity Health Plan Of New Jersey Insurance Comp22Prior authorization required
Hm Health Insurance Company20No prior authorization
Longevity Health Plan Of Colorado, INC.11Prior authorization required
Tsg Guard, INC.11Prior authorization required
Local Initiative Health Authority For La County10No prior authorization
Wellpoint Health Plans, INC.11Prior authorization required
Longevity Health Plan Of Florida, INC.11Prior authorization required
Imperial County Local Health Authority11Prior authorization required
Community Care Health Plan, INC.11Prior authorization required
Independent Care Health Plan11Prior authorization required
HMO Minnesota11Prior authorization required
Upper Peninsula Health Plan, LLC11Prior authorization required
Oklahoma Superior Select, INC.10No prior authorization
Allcare Health Plan, INC.11Prior authorization required
Ghs Health Maintenance Organization, INC.11Prior authorization required
Santa Clara County Health Authority11Prior authorization required
Kern Health Systems11Prior authorization required
Hap Caresource11Prior 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
Santa Cruz Monterey Merced San Benito Mariposa Managed Medic11Prior authorization required
San Joaquin County Health Commission11Prior authorization required
Banner Health Plan, INC.11Prior authorization required
Aids Healthcare Foundation11Prior authorization required
San Mateo Health Commission10No prior authorization
Caresource Ohio, INC.11Prior authorization required
Lagniappe Advantage Insurance Company10No prior authorization
American Health Plan Of Fl, INC.10No prior authorization
Longevity Health Plan Of Michigan, INC.11Prior authorization required
Santa Barbara San Luis Obispo Regional Health Authority Dba11Prior authorization required
American Health Plan, INC.10No prior authorization
San Francisco Health Authority Dba San Francisco Health Plan11Prior authorization required
Longevity Health Plan Of New York, INC.11Prior authorization required
Dignity Care Corporation10No prior authorization
Healthy Mississippi, INC.11Prior authorization required
Inland Empire Health Plan11Prior authorization required
West Virginia Senior Advantage, INC.11Prior authorization required
Longevity Health Plan Of Illinois, INC.11Prior authorization required
Ventura County Medi-Cal Managed Care Commission11Prior 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
Horizon Insurance Company11Prior authorization required

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