Does Medicare Part D cover Pegasys?
Pegasys appears on the Medicare Part D formularies of 317 payers in the corpus, across 5,496 plans. 195 payers require prior authorization on every covering plan, 4 on some plans, and 118 on none.
Beyond prior authorization: 0 covering plans require step therapy (another drug tried first) and 1,878 apply a quantity limit, on at least one Pegasys 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
| Payer | Plans covering | Require prior auth | Step therapy | Quantity limit | Status |
|---|---|---|---|---|---|
| Humana | 817 | 817 | 0 | 817 | Prior authorization required |
| UnitedHealthcare | 731 | 731 | 0 | 0 | Prior authorization required |
| Aetna (CVS Health) | 658 | 653 | 0 | 5 | Varies by plan |
| Devoted Health | 415 | 415 | 0 | 0 | Prior authorization required |
| Blue Cross Blue Shield (affiliate) | 269 | 171 | 0 | 0 | Varies by plan |
| Centene (WellCare) | 197 | 197 | 0 | 197 | Prior authorization required |
| Cigna | 171 | 0 | 0 | 171 | No prior authorization |
| Kaiser Permanente | 115 | 0 | 0 | 0 | No prior authorization |
| SCAN Health Plan | 74 | 74 | 0 | 0 | Prior authorization required |
| Elevance Health (Anthem) | 67 | 2 | 0 | 0 | Varies by plan |
| Alignment Healthcare | 67 | 67 | 0 | 0 | Prior authorization required |
| Medco Containment Life And Medco Containment Ny | 60 | 0 | 0 | 60 | No prior authorization |
| Molina Healthcare | 51 | 51 | 0 | 0 | Prior authorization required |
| Simply Healthcare Plans, INC. | 50 | 0 | 0 | 0 | No prior authorization |
| Cariten Health Plan INC. | 44 | 44 | 0 | 44 | Prior authorization required |
| Uhc Of California | 40 | 40 | 0 | 0 | Prior authorization required |
| Priority Health | 37 | 0 | 0 | 0 | No prior authorization |
| Careplus Health Plans, INC. | 36 | 36 | 0 | 36 | Prior authorization required |
| Bravo Health Pennsylvania, INC. | 35 | 0 | 0 | 35 | No prior authorization |
| Preferred Care Partners, INC. | 35 | 35 | 0 | 0 | Prior authorization required |
| Zing Health Of Michigan, INC. | 33 | 33 | 0 | 0 | Prior authorization required |
| Health Care Service Corporation | 31 | 31 | 0 | 0 | Prior authorization required |
| Solis Health Plans, INC. | 24 | 24 | 0 | 0 | Prior authorization required |
| Sunshine State Health Plan, INC. | 24 | 24 | 0 | 24 | Prior authorization required |
| Freedom Health, INC. | 24 | 0 | 0 | 0 | No prior authorization |
| Capital Advantage Insurance Company | 23 | 23 | 0 | 0 | Prior authorization required |
| Triple S Advantage, INC. | 22 | 22 | 0 | 0 | Prior authorization required |
| Physicians Health Choice Of Texas, LLC | 22 | 22 | 0 | 0 | Prior authorization required |
| Tufts Associated Health Maintenance Organization | 21 | 0 | 0 | 21 | No prior authorization |
| Mmm Healthcare, LLC | 20 | 20 | 0 | 0 | Prior authorization required |
| Mcs Advantage, INC. | 20 | 20 | 0 | 0 | Prior authorization required |
| Harmony Health Plan, INC. | 19 | 19 | 0 | 19 | Prior authorization required |
| Hcsc Insurance Services Company | 18 | 18 | 0 | 0 | Prior authorization required |
| California Physicians' Service | 17 | 17 | 0 | 17 | Prior authorization required |
| Medica Health Plans | 17 | 0 | 0 | 17 | No prior authorization |
| Upmc Health Plan, INC. | 17 | 0 | 0 | 17 | No prior authorization |
| Bluecross Blueshield Of Tennessee, INC. | 17 | 0 | 0 | 17 | No prior authorization |
| Wellpoint Texas, INC. | 16 | 0 | 0 | 0 | No prior authorization |
| Ultimate Health Plans, INC. | 16 | 16 | 0 | 0 | Prior authorization required |
| Excellus Health Plan, INC. | 16 | 0 | 0 | 16 | No prior authorization |
| Medical Mutual Of Ohio | 16 | 0 | 0 | 16 | No prior authorization |
| Superior Healthplan, INC. | 15 | 15 | 0 | 15 | Prior authorization required |
| Florida Blue Medicare, INC. | 15 | 13 | 0 | 2 | Varies by plan |
| Optimum Healthcare, INC. | 15 | 0 | 0 | 0 | No prior authorization |
| Central Health Plan Of California, INC. | 15 | 15 | 0 | 0 | Prior authorization required |
| Blue Care Network Of Michigan | 15 | 0 | 0 | 0 | No prior authorization |
| Selecthealth, INC. | 14 | 14 | 0 | 14 | Prior authorization required |
| Wellpoint Insurance Company | 14 | 0 | 0 | 0 | No prior authorization |
| Peoples Health, INC. | 13 | 13 | 0 | 0 | Prior authorization required |
| Clover Health | 13 | 13 | 0 | 0 | Prior authorization required |
| Healthsun Health Plans, INC. | 13 | 0 | 0 | 0 | No prior authorization |
| Prominence Healthfirst Of Texas | 13 | 0 | 0 | 0 | No prior authorization |
| Atrio Health Plans | 12 | 12 | 0 | 0 | Prior authorization required |
| Upmc Health Network, INC. | 12 | 0 | 0 | 12 | No prior authorization |
| HMO Louisiana, INC. | 12 | 0 | 0 | 12 | No prior authorization |
| Mount Carmel Health Plan, INC. | 11 | 11 | 0 | 0 | Prior authorization required |
| Pacificsource Community Health Plans | 11 | 11 | 0 | 0 | Prior authorization required |
| Community Insurance Company | 10 | 0 | 0 | 0 | No prior authorization |
| Health Insurance Plan Of Greater New York | 10 | 10 | 0 | 0 | Prior authorization required |
| HMO Colorado, INC. | 10 | 0 | 0 | 0 | No prior authorization |
| Quartz Health Plan Corporation | 10 | 10 | 0 | 0 | Prior authorization required |
| Compcare Health Services Insurance Corporation | 10 | 0 | 0 | 0 | No prior authorization |
| Sanford Health Plan | 9 | 9 | 0 | 0 | Prior authorization required |
| Allina Health And Aetna Insurance Company | 9 | 9 | 0 | 0 | Prior authorization required |
| Geisinger Health Plan | 9 | 0 | 0 | 9 | No prior authorization |
| Doctors Healthcare Plans, INC. | 9 | 9 | 0 | 0 | Prior authorization required |
| New York Quality Healthcare Corporation | 9 | 9 | 0 | 9 | Prior authorization required |
| Wellpoint Tennessee, INC. | 9 | 0 | 0 | 0 | No prior authorization |
| Healthier New Jersey Insurance Company | 8 | 8 | 0 | 0 | Prior authorization required |
| Meridian Health Plan Of Michigan, INC. | 8 | 8 | 0 | 8 | Prior authorization required |
| Healthpartners, INC. | 8 | 8 | 0 | 8 | Prior authorization required |
| American Progressive Life & Hlth Ins Company Of Ny | 8 | 8 | 0 | 8 | Prior authorization required |
| Mvp Health Plan, INC. | 8 | 8 | 0 | 0 | Prior authorization required |
| Keystone Health Plan East, INC. | 8 | 0 | 0 | 0 | No prior authorization |
| Network Health Insurance Corporation | 8 | 0 | 0 | 0 | No prior authorization |
| Prominence Healthfirst | 8 | 0 | 0 | 0 | No prior authorization |
| Fallon Community Health Plan | 8 | 0 | 0 | 0 | No prior authorization |
| Peak Health Insurance Corporation | 8 | 0 | 0 | 8 | No prior authorization |
| Health Partners Plans, INC. | 8 | 0 | 0 | 0 | No prior authorization |
| Medco Containment Life & Medco Containment Ny & Health Care | 8 | 8 | 0 | 0 | Prior authorization required |
| Viva Health, INC. | 7 | 7 | 0 | 0 | Prior authorization required |
| Martin'S Point Generations Advantage, INC. | 7 | 7 | 0 | 0 | Prior authorization required |
| Wellpoint Health Plans, INC. | 7 | 0 | 0 | 0 | No prior authorization |
| Astiva Health, INC. | 7 | 7 | 0 | 0 | Prior authorization required |
| Bravo Health Mid-Atlantic, INC. | 7 | 0 | 0 | 7 | No prior authorization |
| Health Alliance Plan Of Michigan | 7 | 7 | 0 | 7 | Prior authorization required |
| Medica Insurance Company | 7 | 0 | 0 | 7 | No prior authorization |
| Summacare INC. | 7 | 7 | 0 | 0 | Prior authorization required |
| Keystone Health Plan Central, INC. | 7 | 7 | 0 | 0 | Prior authorization required |
| Champion Health Plan Of California INC | 7 | 7 | 0 | 0 | Prior authorization required |
| Essence Healthcare PPO, INC. | 7 | 0 | 0 | 7 | No prior authorization |
| Champion Health Plan Of Nevada, INC. | 7 | 7 | 0 | 0 | Prior authorization required |
| Bluecross And Blueshield Of South Carolina | 7 | 7 | 0 | 0 | Prior authorization required |
| Providence Health Assurance | 7 | 0 | 0 | 0 | No prior authorization |
| Alterwood Advantage, INC. | 7 | 7 | 0 | 0 | Prior authorization required |
| Mass General Brigham Health Plan, INC | 6 | 6 | 0 | 0 | Prior authorization required |
| Buckeye Community Health Plan, INC. | 6 | 6 | 0 | 6 | Prior authorization required |
| Christus Health Plan | 6 | 6 | 0 | 0 | Prior authorization required |
| Nebraska Total Care, INC. | 6 | 6 | 0 | 6 | Prior authorization required |
| Gold Kidney Of Florida INC | 6 | 6 | 0 | 0 | Prior authorization required |
| Essence Healthcare, INC. | 6 | 0 | 0 | 6 | No prior authorization |
| Hometown Health Plan, INC. | 6 | 6 | 0 | 0 | Prior authorization required |
| Presbyterian Health Plan | 6 | 0 | 0 | 0 | No prior authorization |
| Elderplan, INC. | 6 | 6 | 0 | 0 | Prior authorization required |
| Perennial Advantage Of Colorado, INC. | 6 | 0 | 0 | 6 | No prior authorization |
| Connecticare, INC. | 6 | 6 | 0 | 0 | Prior authorization required |
| Globalhealth, INC. | 6 | 6 | 0 | 0 | Prior authorization required |
| Preferred Care Network, INC. | 6 | 6 | 0 | 0 | Prior authorization required |
| Scott And White Health Plan | 6 | 6 | 0 | 0 | Prior authorization required |
| Coordinated Care Of Washington, INC. | 5 | 5 | 0 | 5 | Prior authorization required |
| Chinese Community Health Plan | 5 | 5 | 0 | 0 | Prior authorization required |
| Hopkins Health Advantage, INC. | 5 | 5 | 0 | 0 | Prior authorization required |
| Alliance Health And Life Insurance Company | 5 | 5 | 0 | 5 | Prior authorization required |
| Sapphire Edge, INC. | 5 | 5 | 0 | 0 | Prior authorization required |
| Independent Health Association, INC. | 5 | 5 | 0 | 0 | Prior authorization required |
| Coordinated Care Corporation | 5 | 5 | 0 | 5 | Prior authorization required |
| Oh Chs Snp INC. | 5 | 5 | 0 | 0 | Prior authorization required |
| Usable Mutual Insurance Company | 5 | 5 | 0 | 0 | Prior authorization required |
| Gold Kidney Of Arizona | 5 | 5 | 0 | 0 | Prior authorization required |
| Meridian Health Plan Of Illinois, INC. | 5 | 5 | 0 | 5 | Prior authorization required |
| Sunflower State Health Plan, INC. | 5 | 5 | 0 | 5 | Prior authorization required |
| Prominence Healthfirst Of Florida INC | 5 | 0 | 0 | 0 | No prior authorization |
| Priority Health Choice, INC. | 5 | 0 | 0 | 0 | No prior authorization |
| Arkansas Health & Wellness Health Plan, INC. | 5 | 5 | 0 | 5 | Prior authorization required |
| Hpmp Of Florida, INC. | 5 | 5 | 0 | 0 | Prior authorization required |
| Home State Health Plan, INC. | 4 | 4 | 0 | 4 | Prior authorization required |
| Baylor Scott & White Insurance Company | 4 | 4 | 0 | 0 | Prior authorization required |
| Care N' Care Insurance Company Of North Carolina | 4 | 4 | 0 | 0 | Prior authorization required |
| Health New England, INC. | 4 | 4 | 0 | 4 | Prior authorization required |
| Pennsylvania Health & Wellness, INC. | 4 | 4 | 0 | 4 | Prior authorization required |
| The Health Plan Of West Virginia, INC. | 4 | 0 | 0 | 4 | No prior authorization |
| Communitycare Government Programs, INC. | 4 | 0 | 0 | 4 | No prior authorization |
| Hawaii Medical Service Association | 4 | 4 | 0 | 0 | Prior authorization required |
| Qcc Insurance Company | 4 | 0 | 0 | 0 | No prior authorization |
| Leon Health, INC. | 4 | 4 | 0 | 0 | Prior authorization required |
| Verda Health Plan Of Texas INC | 4 | 4 | 0 | 0 | Prior authorization required |
| Security Health Plan Of Wisconsin, INC. | 4 | 4 | 0 | 0 | Prior authorization required |
| Sharp Health Plan | 4 | 4 | 0 | 0 | Prior authorization required |
| Gateway Health Plan, INC. | 4 | 0 | 0 | 0 | No prior authorization |
| Capital Health Plan | 4 | 4 | 0 | 0 | Prior authorization required |
| Boston Medical Center Health Plan, INC. | 4 | 0 | 0 | 4 | No prior authorization |
| Bluecross Blueshield Kansas Solutions, INC. | 4 | 4 | 0 | 0 | Prior authorization required |
| Clever Care Of Golden State, INC. | 4 | 4 | 0 | 0 | Prior authorization required |
| Central Mass Health, LLC | 4 | 4 | 0 | 0 | Prior authorization required |
| Ghs Insurance Company | 4 | 4 | 0 | 0 | Prior authorization required |
| Thp Insurance Company | 4 | 0 | 0 | 4 | No prior authorization |
| Aspire Health Plan | 4 | 4 | 0 | 0 | Prior authorization required |
| Amh Health, LLC | 4 | 0 | 0 | 0 | No prior authorization |
| Dean Health Plan, INC. | 4 | 0 | 0 | 4 | No prior authorization |
| Quartz Health Plan Mn Corporation | 4 | 4 | 0 | 0 | Prior authorization required |
| Medisun, INC. | 3 | 3 | 0 | 0 | Prior authorization required |
| Metroplus Health Plan, INC. | 3 | 3 | 0 | 0 | Prior authorization required |
| Wellpoint West Virginia , INC. | 3 | 0 | 0 | 0 | No prior authorization |
| Louisiana Health Service & Indemnity Company | 3 | 0 | 0 | 3 | No prior authorization |
| Eternalhealth, INC. | 3 | 3 | 0 | 0 | Prior authorization required |
| Patrius Health, INC. | 3 | 3 | 0 | 0 | Prior authorization required |
| Marquis Advantage, INC. | 3 | 0 | 0 | 3 | No prior authorization |
| Partners Insurance Company INC | 3 | 0 | 0 | 0 | No prior authorization |
| Mount Carmel Health Insurance Company | 3 | 3 | 0 | 0 | Prior authorization required |
| Community Care Health Plan Of Louisiana, INC. | 3 | 0 | 0 | 0 | No prior authorization |
| Village Senior Services Corporation | 3 | 3 | 0 | 0 | Prior authorization required |
| Trillium Community Health Plan, INC. | 3 | 3 | 0 | 3 | Prior authorization required |
| Senior Whole Health, LLC | 3 | 3 | 0 | 0 | Prior authorization required |
| Baycare Select Health Plans, INC. | 3 | 3 | 0 | 0 | Prior authorization required |
| Cox Health Systems HMO INC | 3 | 3 | 0 | 0 | Prior authorization required |
| Secur INC | 3 | 0 | 0 | 3 | No prior authorization |
| Wellpoint New Jersey, INC. | 3 | 0 | 0 | 0 | No prior authorization |
| Volunteer State Health Plan | 3 | 0 | 0 | 3 | No prior authorization |
| Align Senior Care California INC. | 3 | 0 | 0 | 3 | No prior authorization |
| Pruitthealth Premier, INC. | 3 | 0 | 0 | 3 | No prior authorization |
| Capital District Physicians' Health Plan, INC. | 3 | 0 | 0 | 3 | No prior authorization |
| Procare Advantage, LLC | 3 | 0 | 0 | 3 | No prior authorization |
| Eternalhealth Of Arizona INC | 3 | 3 | 0 | 0 | Prior authorization required |
| Paramount Care, INC. | 3 | 3 | 0 | 0 | Prior authorization required |
| Aultcare Health Insuring Corporation | 3 | 3 | 0 | 0 | Prior authorization required |
| Mount Carmel Health Plan Of Idaho, INC. | 3 | 3 | 0 | 0 | Prior authorization required |
| Geisinger Indemnity Insurance Company | 3 | 0 | 0 | 3 | No prior authorization |
| Simpra Advantage, INC. | 3 | 0 | 0 | 3 | No prior authorization |
| Provider Partners Health Plan Of Pennsylvania, INC | 3 | 3 | 0 | 0 | Prior authorization required |
| Provider Partners Health Plan Of North Carolina | 3 | 3 | 0 | 0 | Prior authorization required |
| Provider Partners Health Plan Of Indiana | 3 | 3 | 0 | 0 | Prior authorization required |
| Celtic Insurance Company | 3 | 3 | 0 | 3 | Prior authorization required |
| Amerihealth Insurance Company Of New Jersey | 3 | 0 | 0 | 0 | No prior authorization |
| Vns Choice | 3 | 3 | 0 | 0 | Prior authorization required |
| Mercy Care | 3 | 3 | 0 | 0 | Prior authorization required |
| Usable HMO, INC. | 3 | 3 | 0 | 0 | Prior authorization required |
| Mclaren Health Plan, INC. | 3 | 3 | 0 | 0 | Prior authorization required |
| Liberty Advantage, LLC | 3 | 0 | 0 | 3 | No prior authorization |
| Southeastern Indiana Health Organization, INC. | 3 | 3 | 0 | 0 | Prior authorization required |
| Managed Health Services Insurance CORP. | 3 | 3 | 0 | 3 | Prior authorization required |
| Perennial Advantage Of Ohio, INC. | 3 | 0 | 0 | 3 | No prior authorization |
| Provider Partners Health Plan Of Missouri, INC. | 3 | 3 | 0 | 0 | Prior authorization required |
| Hamaspik, INC. | 2 | 2 | 0 | 0 | Prior authorization required |
| Arizona Physicians Ipa, INC. | 2 | 2 | 0 | 0 | Prior authorization required |
| Ks Plan Administrators, LLC | 2 | 2 | 0 | 0 | Prior authorization required |
| Carepartners Of Connecticut, INC. | 2 | 0 | 0 | 2 | No prior authorization |
| Amerihealth Caritas Vip Next, INC. | 2 | 2 | 0 | 2 | Prior authorization required |
| Beshp, INC. | 2 | 2 | 0 | 0 | Prior authorization required |
| Wellpoint Iowa, INC. | 2 | 0 | 0 | 0 | No prior authorization |
| Commonwealth Care Alliance, INC. | 2 | 2 | 0 | 0 | Prior authorization required |
| Arkansas Superior Select, INC. | 2 | 2 | 0 | 0 | Prior authorization required |
| Wellpoint Washington, INC. | 2 | 0 | 0 | 0 | No prior authorization |
| Neighborhood Health Plan Of Rhode Island | 2 | 2 | 0 | 0 | Prior authorization required |
| Lifeworks Advantage, LLC | 2 | 0 | 0 | 2 | No prior authorization |
| Kansas Superior Select, INC. | 2 | 0 | 0 | 2 | No prior authorization |
| Signature Advantage, LLC | 2 | 2 | 0 | 0 | Prior authorization required |
| Primewest Rural Mn Health Care Access Initiative | 2 | 2 | 0 | 0 | Prior authorization required |
| South Country Health Alliance | 2 | 2 | 0 | 0 | Prior authorization required |
| Sentara Health Plans | 2 | 0 | 0 | 2 | No prior authorization |
| Verda Health Plan Of Arizona, INC. | 2 | 2 | 0 | 0 | Prior authorization required |
| Partners Insurance Company Of New Jersey INC | 2 | 0 | 0 | 0 | No prior authorization |
| Sanford Health Plan Of Minnesota | 2 | 2 | 0 | 0 | Prior authorization required |
| Nhc Advantage, LLC | 2 | 0 | 0 | 2 | No prior authorization |
| Vista Health Plan, INC. | 2 | 2 | 0 | 2 | Prior authorization required |
| American Health Plan Of Ut, INC. | 2 | 0 | 0 | 2 | No prior authorization |
| Upmc For You, INC | 2 | 0 | 0 | 2 | No prior authorization |
| American Health Plan Of Missouri, INC. | 2 | 0 | 0 | 2 | No prior authorization |
| Selectcare Of Texas, INC. | 2 | 2 | 0 | 2 | Prior authorization required |
| New Century Health Plan, INC. | 2 | 2 | 0 | 0 | Prior authorization required |
| Troy Health, INC. | 2 | 2 | 0 | 0 | Prior authorization required |
| Community Health Group | 2 | 2 | 0 | 0 | Prior authorization required |
| Banner - University Care Advantage | 2 | 0 | 0 | 2 | No prior authorization |
| Texas Independence Health Plan, INC. | 2 | 2 | 0 | 0 | Prior authorization required |
| Tufts Health Public Plans, INC. | 2 | 0 | 0 | 2 | No prior authorization |
| Imperial Health Plan Of California, INC. | 2 | 2 | 0 | 0 | Prior authorization required |
| Bridgeway Health Solutions Of Arizona, INC. | 2 | 2 | 0 | 2 | Prior authorization required |
| Denver Health Medical Plan, INC. | 2 | 2 | 0 | 0 | Prior authorization required |
| Community Health Plan Of Washington | 2 | 0 | 0 | 2 | No prior authorization |
| Senior Whole Health Of New York, INC. | 2 | 2 | 0 | 0 | Prior authorization required |
| Nextblue Of North Dakota Insurance Company | 2 | 0 | 0 | 0 | No prior authorization |
| Healthpartners Insurance Company | 2 | 2 | 0 | 2 | Prior authorization required |
| Missouri Care, Incorporated | 2 | 0 | 0 | 0 | No prior authorization |
| Pruitthealth Premier North Carolina, LLC | 2 | 0 | 0 | 2 | No prior authorization |
| Elite Health Plan, INC. | 2 | 2 | 0 | 0 | Prior authorization required |
| American Health Plan Of Iowa INC | 2 | 0 | 0 | 2 | No prior authorization |
| Elderserve Health, INC. | 2 | 0 | 0 | 2 | No prior authorization |
| Align Senior Care Mi, LLC | 2 | 0 | 0 | 2 | No prior authorization |
| Isnp Ventures, LLC | 2 | 0 | 0 | 2 | No prior authorization |
| Memorial Hermann Health Plan | 2 | 2 | 0 | 0 | Prior authorization required |
| Good Samaritan Insurance Plan Of Nebraska, INC. | 2 | 2 | 0 | 0 | Prior authorization required |
| Excellus Health Plan Community Care LLC | 2 | 0 | 0 | 2 | No prior authorization |
| Group Health Cooperative Of Eau Claire | 2 | 0 | 0 | 2 | No prior authorization |
| Georgia Assurance, INC. | 2 | 0 | 0 | 2 | No prior authorization |
| Caresource Georgia CO. | 2 | 0 | 0 | 2 | No prior authorization |
| Visiting Nurse Association Of Central New York | 2 | 2 | 0 | 0 | Prior authorization required |
| Trinity Health Plan Of Michigan INC | 2 | 2 | 0 | 0 | Prior authorization required |
| Wyoblue Advantage INC | 2 | 0 | 0 | 0 | No prior authorization |
| Community Health Choice Texas, INC. | 2 | 0 | 0 | 2 | No prior authorization |
| Mount Carmel Health Plan Of New York, INC. | 2 | 2 | 0 | 0 | Prior authorization required |
| Align Senior Care Florida, INC. | 2 | 0 | 0 | 2 | No prior authorization |
| Longevity Health Plan Of New Jersey Insurance Comp | 2 | 0 | 0 | 2 | No prior authorization |
| Hm Health Insurance Company | 2 | 2 | 0 | 0 | Prior authorization required |
| Horizon Insurance Company | 2 | 2 | 0 | 0 | Prior authorization required |
| Longevity Health Plan Of Colorado, INC. | 1 | 0 | 0 | 1 | No prior authorization |
| Tsg Guard, INC. | 1 | 1 | 0 | 0 | Prior authorization required |
| Local Initiative Health Authority For La County | 1 | 0 | 0 | 1 | No prior authorization |
| Johns Hopkins Health Plan Of Virginia, INC. | 1 | 1 | 0 | 0 | Prior authorization required |
| Longevity Health Plan Of Florida, INC. | 1 | 0 | 0 | 1 | No prior authorization |
| Imperial County Local Health Authority | 1 | 1 | 0 | 0 | Prior authorization required |
| Community Care Health Plan, INC. | 1 | 0 | 0 | 0 | No prior authorization |
| Alameda Alliance For Health | 1 | 1 | 0 | 0 | Prior authorization required |
| Independent Care Health Plan | 1 | 1 | 0 | 1 | Prior authorization required |
| Itasca Medical Care | 1 | 1 | 0 | 0 | Prior authorization required |
| HMO Minnesota | 1 | 1 | 0 | 0 | Prior authorization required |
| Amerihealth Caritas Louisiana, INC. | 1 | 1 | 0 | 1 | Prior authorization required |
| Wellpoint South Carolina, INC. | 1 | 0 | 0 | 0 | No prior authorization |
| Upper Peninsula Health Plan, LLC | 1 | 0 | 0 | 1 | No prior authorization |
| Connecticare Insurance Company, INC. | 1 | 1 | 0 | 0 | Prior authorization required |
| Independent Health Benefits Corporation | 1 | 1 | 0 | 0 | Prior authorization required |
| Oklahoma Superior Select, INC. | 1 | 0 | 0 | 1 | No prior authorization |
| Provider Partners Health Plan Of Illinois | 1 | 1 | 0 | 0 | Prior authorization required |
| Allcare Health Plan, INC. | 1 | 1 | 0 | 0 | Prior authorization required |
| Samaritan Health Plans, INC. | 1 | 1 | 0 | 0 | Prior authorization required |
| Ghs Health Maintenance Organization, INC. | 1 | 1 | 0 | 0 | Prior authorization required |
| Santa Clara County Health Authority | 1 | 1 | 0 | 0 | Prior authorization required |
| Provider Partners Health Plan Of Texas, INC. | 1 | 1 | 0 | 0 | Prior authorization required |
| Kern Health Systems | 1 | 1 | 0 | 0 | Prior authorization required |
| Hap Caresource | 1 | 0 | 0 | 1 | No prior authorization |
| Select Health Of South Carolina, INC. | 1 | 1 | 0 | 1 | Prior authorization required |
| Contra Costa County Medical Service Dba Contra Costa Health | 1 | 1 | 0 | 0 | Prior authorization required |
| Paramount Insurance Company | 1 | 1 | 0 | 0 | Prior authorization required |
| Absolute Total Care, INC. | 1 | 1 | 0 | 1 | Prior authorization required |
| Longevity Health Plan Of North Carolina, INC. | 1 | 0 | 0 | 1 | No prior authorization |
| Orange County Health Authority | 1 | 1 | 0 | 0 | Prior authorization required |
| Health Choice Arizona, INC. | 1 | 1 | 0 | 0 | Prior authorization required |
| Santa Cruz Monterey Merced San Benito Mariposa Managed Medic | 1 | 1 | 0 | 0 | Prior authorization required |
| San Joaquin County Health Commission | 1 | 1 | 0 | 0 | Prior authorization required |
| Banner Health Plan, INC. | 1 | 0 | 0 | 1 | No prior authorization |
| Aids Healthcare Foundation | 1 | 1 | 0 | 0 | Prior authorization required |
| Health Plan Of Careoregon, INC. | 1 | 1 | 0 | 1 | Prior authorization required |
| Alohacare | 1 | 1 | 0 | 0 | Prior authorization required |
| San Mateo Health Commission | 1 | 1 | 0 | 0 | Prior authorization required |
| Amerihealth Michigan, INC. | 1 | 1 | 0 | 1 | Prior authorization required |
| Amerihealth Caritas Florida, INC. | 1 | 1 | 0 | 1 | Prior authorization required |
| Caresource Ohio, INC. | 1 | 0 | 0 | 1 | No prior authorization |
| Lagniappe Advantage Insurance Company | 1 | 0 | 0 | 1 | No prior authorization |
| American Health Plan Of Fl, INC. | 1 | 0 | 0 | 1 | No prior authorization |
| Upmc Health Coverage, INC. | 1 | 0 | 0 | 1 | No prior authorization |
| Provider Partners Health Plan Of Kentucky | 1 | 1 | 0 | 0 | Prior authorization required |
| Longevity Health Plan Of Michigan, INC. | 1 | 0 | 0 | 1 | No prior authorization |
| Santa Barbara San Luis Obispo Regional Health Authority Dba | 1 | 1 | 0 | 0 | Prior authorization required |
| American Health Plan, INC. | 1 | 0 | 0 | 1 | No prior authorization |
| San Francisco Health Authority Dba San Francisco Health Plan | 1 | 1 | 0 | 0 | Prior authorization required |
| Amerihealth Caritas North Carolina, INC. | 1 | 1 | 0 | 1 | Prior authorization required |
| Horizon Healthcare Of New Jersey, INC. | 1 | 1 | 0 | 0 | Prior authorization required |
| Longevity Health Plan Of New York, INC. | 1 | 0 | 0 | 1 | No prior authorization |
| Hawaii Medical Service Association (Hmsa) | 1 | 1 | 0 | 0 | Prior authorization required |
| Dignity Care Corporation | 1 | 0 | 0 | 1 | No prior authorization |
| Healthy Mississippi, INC. | 1 | 1 | 0 | 1 | Prior authorization required |
| Inland Empire Health Plan | 1 | 1 | 0 | 0 | Prior authorization required |
| West Virginia Senior Advantage, INC. | 1 | 1 | 0 | 0 | Prior authorization required |
| Longevity Health Plan Of Illinois, INC. | 1 | 0 | 0 | 1 | No prior authorization |
| Ventura County Medi-Cal Managed Care Commission | 1 | 1 | 0 | 0 | Prior authorization required |
| Healthfirst Insurance Company, INC. | 1 | 1 | 0 | 0 | Prior authorization required |
| American Health Plan Of Indiana INC | 1 | 0 | 0 | 1 | No prior authorization |
| American Health Plan Of Ms, INC. | 1 | 0 | 0 | 1 | No prior authorization |
| American Health Plan Of Pennsylvania INC | 1 | 0 | 0 | 1 | No prior authorization |
“Require prior auth”, “step therapy” and “quantity limit” each count a plan when any Pegasys 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.