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Does Medicare Part D cover Pegasys?

Pegasys appears on the Medicare Part D formularies of 317 payers in the corpus. 195 require prior authorization on every covering plan, 4 on some plans, and 118 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
UnitedHealthcare731731Prior authorization required
Aetna (CVS Health)658653Varies by plan
Devoted Health415415Prior authorization required
Blue Cross Blue Shield (affiliate)269171Varies by plan
Centene (WellCare)197197Prior authorization required
Cigna1710No prior authorization
Kaiser Permanente1150No prior authorization
SCAN Health Plan7474Prior authorization required
Elevance Health (Anthem)672Varies by plan
Alignment Healthcare6767Prior authorization required
Medco Containment Life And Medco Containment Ny600No prior authorization
Molina Healthcare5151Prior authorization required
Simply Healthcare Plans, INC.500No prior authorization
Cariten Health Plan INC.4444Prior authorization required
Uhc Of California4040Prior authorization required
Priority Health370No prior authorization
Careplus Health Plans, INC.3636Prior authorization required
Bravo Health Pennsylvania, INC.350No prior authorization
Preferred Care Partners, INC.3535Prior authorization required
Zing Health Of Michigan, INC.3333Prior authorization required
Health Care Service Corporation3131Prior authorization required
Solis Health Plans, INC.2424Prior authorization required
Sunshine State Health Plan, INC.2424Prior authorization required
Freedom Health, INC.240No prior authorization
Capital Advantage Insurance Company2323Prior authorization required
Triple S Advantage, INC.2222Prior authorization required
Physicians Health Choice Of Texas, LLC2222Prior authorization required
Tufts Associated Health Maintenance Organization210No prior authorization
Mmm Healthcare, LLC2020Prior authorization required
Mcs Advantage, INC.2020Prior authorization required
Harmony Health Plan, INC.1919Prior authorization required
Hcsc Insurance Services Company1818Prior authorization required
California Physicians' Service1717Prior authorization required
Medica Health Plans170No prior authorization
Upmc Health Plan, INC.170No prior authorization
Bluecross Blueshield Of Tennessee, INC.170No prior authorization
Wellpoint Texas, INC.160No prior authorization
Ultimate Health Plans, INC.1616Prior authorization required
Excellus Health Plan, INC.160No prior authorization
Medical Mutual Of Ohio160No prior authorization
Superior Healthplan, INC.1515Prior authorization required
Florida Blue Medicare, INC.1513Varies by plan
Optimum Healthcare, INC.150No prior authorization
Central Health Plan Of California, INC.1515Prior authorization required
Blue Care Network Of Michigan150No prior authorization
Selecthealth, INC.1414Prior authorization required
Wellpoint Insurance Company140No prior authorization
Peoples Health, INC.1313Prior authorization required
Clover Health1313Prior authorization required
Healthsun Health Plans, INC.130No prior authorization
Prominence Healthfirst Of Texas130No prior authorization
Atrio Health Plans1212Prior authorization required
Upmc Health Network, INC.120No prior authorization
HMO Louisiana, INC.120No prior authorization
Mount Carmel Health Plan, INC.1111Prior authorization required
Pacificsource Community Health Plans1111Prior authorization required
Community Insurance Company100No prior authorization
Health Insurance Plan Of Greater New York1010Prior authorization required
HMO Colorado, INC.100No prior authorization
Quartz Health Plan Corporation1010Prior authorization required
Compcare Health Services Insurance Corporation100No prior authorization
Sanford Health Plan99Prior authorization required
Allina Health And Aetna Insurance Company99Prior authorization required
Geisinger Health Plan90No prior authorization
Doctors Healthcare Plans, INC.99Prior authorization required
New York Quality Healthcare Corporation99Prior authorization required
Wellpoint Tennessee, INC.90No prior authorization
Healthier New Jersey Insurance Company88Prior authorization required
Meridian Health Plan Of Michigan, INC.88Prior authorization required
Healthpartners, INC.88Prior authorization required
American Progressive Life & Hlth Ins Company Of Ny88Prior authorization required
Mvp Health Plan, INC.88Prior authorization required
Keystone Health Plan East, INC.80No prior authorization
Network Health Insurance Corporation80No prior authorization
Prominence Healthfirst80No prior authorization
Fallon Community Health Plan80No prior authorization
Peak Health Insurance Corporation80No prior authorization
Health Partners Plans, INC.80No prior authorization
Medco Containment Life & Medco Containment Ny & Health Care88Prior authorization required
Viva Health, INC.77Prior authorization required
Martin'S Point Generations Advantage, INC.77Prior authorization required
Wellpoint Health Plans, INC.70No prior authorization
Astiva Health, INC.77Prior authorization required
Bravo Health Mid-Atlantic, INC.70No prior authorization
Health Alliance Plan Of Michigan77Prior authorization required
Medica Insurance Company70No prior authorization
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.70No prior authorization
Champion Health Plan Of Nevada, INC.77Prior authorization required
Bluecross And Blueshield Of South Carolina77Prior authorization required
Providence Health Assurance70No prior authorization
Alterwood Advantage, INC.77Prior authorization required
Mass General Brigham Health Plan, INC66Prior authorization required
Buckeye Community Health Plan, INC.66Prior authorization required
Christus Health Plan66Prior authorization required
Nebraska Total Care, INC.66Prior authorization required
Gold Kidney Of Florida INC66Prior authorization required
Essence Healthcare, INC.60No prior authorization
Hometown Health Plan, INC.66Prior authorization required
Presbyterian Health Plan60No prior authorization
Elderplan, INC.66Prior authorization required
Perennial Advantage Of Colorado, INC.60No prior authorization
Connecticare, INC.66Prior authorization required
Globalhealth, INC.66Prior authorization required
Preferred Care Network, 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
Hopkins Health Advantage, INC.55Prior authorization required
Alliance Health And Life Insurance Company55Prior authorization required
Sapphire Edge, INC.55Prior authorization required
Independent Health Association, INC.55Prior authorization required
Coordinated Care Corporation55Prior authorization required
Oh Chs Snp INC.55Prior authorization required
Usable Mutual Insurance Company55Prior authorization required
Gold Kidney Of Arizona55Prior authorization required
Meridian Health Plan Of Illinois, INC.55Prior authorization required
Sunflower State Health Plan, INC.55Prior authorization required
Prominence Healthfirst Of Florida INC50No prior authorization
Priority Health Choice, INC.50No prior authorization
Arkansas Health & Wellness Health Plan, INC.55Prior authorization required
Hpmp Of Florida, INC.55Prior authorization required
Home State Health Plan, INC.44Prior authorization required
Baylor Scott & White Insurance Company44Prior authorization required
Care N' Care Insurance Company Of North Carolina44Prior authorization required
Health New England, INC.44Prior authorization required
Pennsylvania Health & Wellness, INC.44Prior authorization required
The Health Plan Of West Virginia, INC.40No prior authorization
Communitycare Government Programs, INC.40No prior authorization
Hawaii Medical Service Association44Prior authorization required
Qcc Insurance Company40No prior authorization
Leon Health, INC.44Prior authorization required
Verda Health Plan Of Texas INC44Prior authorization required
Security Health Plan Of Wisconsin, INC.44Prior authorization required
Sharp Health Plan44Prior authorization required
Gateway Health Plan, INC.40No prior authorization
Capital Health Plan44Prior authorization required
Boston Medical Center Health Plan, INC.40No prior authorization
Bluecross Blueshield Kansas Solutions, INC.44Prior authorization required
Clever Care Of Golden State, INC.44Prior authorization required
Central Mass Health, LLC44Prior authorization required
Ghs Insurance Company44Prior authorization required
Thp Insurance Company40No prior authorization
Aspire Health Plan44Prior authorization required
Amh Health, LLC40No prior authorization
Dean Health Plan, INC.40No prior authorization
Quartz Health Plan Mn Corporation44Prior authorization required
Medisun, INC.33Prior authorization required
Metroplus Health Plan, INC.33Prior authorization required
Wellpoint West Virginia , INC.30No prior authorization
Louisiana Health Service & Indemnity Company30No prior authorization
Eternalhealth, INC.33Prior authorization required
Patrius Health, INC.33Prior authorization required
Marquis Advantage, INC.30No prior authorization
Partners Insurance Company INC30No prior authorization
Mount Carmel Health Insurance Company33Prior authorization required
Community Care Health Plan Of Louisiana, INC.30No prior authorization
Village Senior Services Corporation33Prior authorization required
Trillium Community Health Plan, INC.33Prior authorization required
Senior Whole Health, LLC33Prior 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.30No prior authorization
Volunteer State Health Plan30No prior authorization
Align Senior Care California INC.30No prior authorization
Pruitthealth Premier, INC.30No prior authorization
Capital District Physicians' Health Plan, INC.30No prior authorization
Procare Advantage, LLC30No prior authorization
Eternalhealth Of Arizona INC33Prior authorization required
Paramount Care, INC.33Prior authorization required
Aultcare Health Insuring Corporation33Prior authorization required
Mount Carmel Health Plan Of Idaho, INC.33Prior authorization required
Geisinger Indemnity Insurance Company30No prior authorization
Simpra Advantage, INC.30No prior authorization
Provider Partners Health Plan Of Pennsylvania, INC33Prior authorization required
Provider Partners Health Plan Of North Carolina33Prior authorization required
Provider Partners Health Plan Of Indiana33Prior authorization required
Celtic Insurance Company33Prior authorization required
Amerihealth Insurance Company Of New Jersey30No prior authorization
Vns Choice33Prior authorization required
Mercy Care33Prior authorization required
Usable HMO, INC.33Prior authorization required
Mclaren Health Plan, INC.33Prior authorization required
Liberty Advantage, LLC30No prior authorization
Southeastern Indiana Health Organization, INC.33Prior authorization required
Managed Health Services Insurance CORP.33Prior authorization required
Perennial Advantage Of Ohio, INC.30No prior authorization
Provider Partners Health Plan Of Missouri, INC.33Prior authorization required
Hamaspik, INC.22Prior authorization required
Arizona Physicians Ipa, INC.22Prior authorization required
Ks Plan Administrators, LLC22Prior authorization required
Carepartners Of Connecticut, INC.20No prior authorization
Amerihealth Caritas Vip Next, INC.22Prior authorization required
Beshp, INC.22Prior authorization required
Wellpoint Iowa, INC.20No prior authorization
Commonwealth Care Alliance, INC.22Prior authorization required
Arkansas Superior Select, INC.22Prior authorization required
Wellpoint Washington, INC.20No prior authorization
Neighborhood Health Plan Of Rhode Island22Prior 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
South Country Health Alliance22Prior authorization required
Sentara Health Plans20No prior authorization
Verda Health Plan Of Arizona, INC.22Prior authorization required
Partners Insurance Company Of New Jersey INC20No prior authorization
Sanford Health Plan Of Minnesota22Prior authorization required
Nhc Advantage, LLC20No prior authorization
Vista Health Plan, INC.22Prior authorization required
American Health Plan Of Ut, INC.20No prior authorization
Upmc For You, INC20No 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
Troy Health, INC.22Prior authorization required
Community Health Group22Prior authorization required
Banner - University Care Advantage20No prior authorization
Texas Independence Health Plan, INC.22Prior authorization required
Tufts Health Public Plans, INC.20No prior authorization
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 Washington20No prior authorization
Senior Whole Health Of New York, INC.22Prior authorization required
Nextblue Of North Dakota Insurance Company20No prior authorization
Healthpartners Insurance Company22Prior authorization required
Missouri Care, Incorporated20No prior authorization
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.20No prior authorization
Align Senior Care Mi, LLC20No prior authorization
Isnp Ventures, LLC20No prior authorization
Memorial Hermann Health Plan22Prior authorization required
Good Samaritan Insurance Plan Of Nebraska, INC.22Prior authorization required
Excellus Health Plan Community Care LLC20No prior authorization
Group Health Cooperative Of Eau Claire20No prior authorization
Georgia Assurance, INC.20No prior authorization
Caresource Georgia CO.20No prior authorization
Visiting Nurse Association Of Central New York22Prior authorization required
Trinity Health Plan Of Michigan INC22Prior authorization required
Wyoblue Advantage INC20No prior authorization
Community Health Choice Texas, INC.20No prior authorization
Mount Carmel Health Plan Of New York, INC.22Prior authorization required
Align Senior Care Florida, INC.20No prior authorization
Longevity Health Plan Of New Jersey Insurance Comp20No prior authorization
Hm Health Insurance Company22Prior authorization required
Horizon Insurance Company22Prior authorization required
Longevity Health Plan Of Colorado, INC.10No prior authorization
Tsg Guard, INC.11Prior authorization required
Local Initiative Health Authority For La County10No prior authorization
Johns Hopkins Health Plan Of Virginia, INC.11Prior authorization required
Longevity Health Plan Of Florida, INC.10No prior authorization
Imperial County Local Health Authority11Prior authorization required
Community Care Health Plan, INC.10No prior authorization
Alameda Alliance For Health11Prior authorization required
Independent Care Health Plan11Prior authorization required
Itasca Medical Care11Prior authorization required
HMO Minnesota11Prior authorization required
Amerihealth Caritas Louisiana, INC.11Prior authorization required
Wellpoint South Carolina, INC.10No prior authorization
Upper Peninsula Health Plan, LLC10No prior authorization
Connecticare Insurance Company, INC.11Prior authorization required
Independent Health Benefits Corporation11Prior authorization required
Oklahoma Superior Select, INC.10No prior authorization
Provider Partners Health Plan Of Illinois11Prior authorization required
Allcare Health Plan, INC.11Prior authorization required
Samaritan Health Plans, INC.11Prior authorization required
Ghs Health Maintenance Organization, INC.11Prior authorization required
Santa Clara County Health Authority11Prior authorization required
Provider Partners Health Plan Of Texas, INC.11Prior authorization required
Kern Health Systems11Prior authorization required
Hap Caresource10No prior authorization
Select Health Of South Carolina, INC.11Prior authorization required
Contra Costa County Medical Service Dba Contra Costa Health11Prior authorization required
Paramount Insurance Company11Prior authorization required
Absolute Total Care, INC.11Prior authorization required
Longevity Health Plan Of North Carolina, INC.10No prior authorization
Orange County Health Authority11Prior authorization required
Health Choice Arizona, INC.11Prior authorization required
Santa Cruz Monterey Merced San Benito Mariposa Managed Medic11Prior authorization required
San Joaquin County Health Commission11Prior authorization required
Banner Health Plan, INC.10No prior authorization
Aids Healthcare Foundation11Prior authorization required
Health Plan Of Careoregon, INC.11Prior authorization required
Alohacare11Prior authorization required
San Mateo Health Commission11Prior authorization required
Amerihealth Michigan, INC.11Prior authorization required
Amerihealth Caritas Florida, INC.11Prior authorization required
Caresource Ohio, INC.10No prior authorization
Lagniappe Advantage Insurance Company10No prior authorization
American Health Plan Of Fl, INC.10No prior authorization
Upmc Health Coverage, INC.10No prior authorization
Provider Partners Health Plan Of Kentucky11Prior authorization required
Longevity Health Plan Of Michigan, INC.10No prior authorization
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
Amerihealth Caritas North Carolina, INC.11Prior authorization required
Horizon Healthcare Of New Jersey, INC.11Prior authorization required
Longevity Health Plan Of New York, INC.10No prior authorization
Hawaii Medical Service Association (Hmsa)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.10No prior authorization
Ventura County Medi-Cal Managed Care Commission11Prior authorization required
Healthfirst Insurance Company, INC.11Prior 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

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