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Does Medicare Part D cover Restasis?

Restasis appears on the Medicare Part D formularies of 152 payers in the corpus, across 3,304 plans. 0 payers require prior authorization on every covering plan, 0 on some plans, and 152 on none.

Beyond prior authorization: 0 covering plans require step therapy (another drug tried first) and 2,468 apply a quantity limit, on at least one Restasis 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
UnitedHealthcare73100731No prior authorization
Aetna (CVS Health)65300636No prior authorization
Devoted Health415000No prior authorization
Blue Cross Blue Shield (affiliate)26900253No prior authorization
Elevance Health (Anthem)670065No prior authorization
Alignment Healthcare670067No prior authorization
Molina Healthcare51000No prior authorization
Simply Healthcare Plans, INC.500050No prior authorization
Uhc Of California400040No prior authorization
Priority Health370037No prior authorization
Preferred Care Partners, INC.350035No prior authorization
Zing Health Of Michigan, INC.33000No prior authorization
Health Care Service Corporation310031No prior authorization
Solis Health Plans, INC.240024No prior authorization
Capital Advantage Insurance Company230023No prior authorization
Triple S Advantage, INC.220022No prior authorization
Physicians Health Choice Of Texas, LLC220022No prior authorization
Tufts Associated Health Maintenance Organization21000No prior authorization
Mmm Healthcare, LLC200020No prior authorization
Hcsc Insurance Services Company180018No prior authorization
California Physicians' Service170017No prior authorization
Bluecross Blueshield Of Tennessee, INC.170017No prior authorization
Wellpoint Texas, INC.160016No prior authorization
Ultimate Health Plans, INC.16000No prior authorization
Excellus Health Plan, INC.16000No prior authorization
Central Health Plan Of California, INC.15000No prior authorization
Blue Care Network Of Michigan150015No prior authorization
Wellpoint Insurance Company140014No prior authorization
Florida Blue Medicare, INC.130013No prior authorization
Peoples Health, INC.130013No prior authorization
Clover Health13000No prior authorization
Healthsun Health Plans, INC.130013No prior authorization
Prominence Healthfirst Of Texas130013No prior authorization
Mount Carmel Health Plan, INC.11000No prior authorization
Community Insurance Company100010No prior authorization
Health Insurance Plan Of Greater New York100010No prior authorization
HMO Colorado, INC.100010No prior authorization
Quartz Health Plan Corporation10000No prior authorization
Compcare Health Services Insurance Corporation100010No prior authorization
Sanford Health Plan9000No prior authorization
Allina Health And Aetna Insurance Company9009No prior authorization
Doctors Healthcare Plans, INC.9009No prior authorization
Wellpoint Tennessee, INC.9009No prior authorization
Healthier New Jersey Insurance Company8008No prior authorization
Healthpartners, INC.8008No prior authorization
Mvp Health Plan, INC.8000No prior authorization
Keystone Health Plan East, INC.8008No prior authorization
Network Health Insurance Corporation8008No prior authorization
Prominence Healthfirst8008No prior authorization
Fallon Community Health Plan8000No prior authorization
Health Partners Plans, INC.8008No prior authorization
Medco Containment Life & Medco Containment Ny & Health Care8008No prior authorization
Viva Health, INC.7000No prior authorization
Martin'S Point Generations Advantage, INC.7000No prior authorization
Wellpoint Health Plans, INC.7007No prior authorization
Keystone Health Plan Central, 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
Christus Health Plan6000No prior authorization
Hometown Health Plan, INC.6000No prior authorization
Presbyterian Health Plan6006No prior authorization
Elderplan, INC.6000No prior authorization
Connecticare, INC.6000No prior authorization
Preferred Care Network, INC.6006No prior authorization
Scott And White Health Plan6006No prior authorization
Hopkins Health Advantage, INC.5000No prior authorization
Sapphire Edge, INC.5005No prior authorization
Usable Mutual Insurance Company5000No prior authorization
Prominence Healthfirst Of Florida INC5005No prior authorization
Priority Health Choice, INC.5005No prior authorization
Hpmp Of Florida, INC.5000No prior authorization
Baylor Scott & White Insurance Company4004No prior authorization
Care N' Care Insurance Company Of North Carolina4000No prior authorization
Health New England, INC.4004No prior authorization
Hawaii Medical Service Association4000No prior authorization
Qcc Insurance Company4004No prior authorization
Security Health Plan Of Wisconsin, INC.4000No prior authorization
Sharp Health Plan4000No prior authorization
Gateway Health Plan, INC.4004No prior authorization
Capital Health Plan4004No prior authorization
Bluecross Blueshield Kansas Solutions, INC.4004No prior authorization
Clever Care Of Golden State, INC.4000No prior authorization
Central Mass Health, LLC4004No prior authorization
Ghs Insurance Company4004No prior authorization
Amh Health, LLC4004No prior authorization
Quartz Health Plan Mn Corporation4000No prior authorization
Medisun, INC.3000No prior authorization
Metroplus Health Plan, INC.3000No prior authorization
Wellpoint West Virginia , INC.3003No prior authorization
Eternalhealth, INC.3000No prior authorization
Patrius Health, INC.3003No prior authorization
Partners Insurance Company INC3003No prior authorization
Mount Carmel Health Insurance Company3000No prior authorization
Community Care Health Plan Of Louisiana, INC.3003No prior authorization
Senior Whole Health, LLC3000No prior authorization
Wellpoint New Jersey, INC.3003No prior authorization
Volunteer State Health Plan3003No prior authorization
Capital District Physicians' Health Plan, INC.3000No 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
Amerihealth Insurance Company Of New Jersey3003No prior authorization
Mercy Care3000No prior authorization
Usable HMO, INC.3000No prior authorization
Provider Partners Health Plan Of Missouri, INC.3000No prior authorization
Hamaspik, INC.2002No prior authorization
Arizona Physicians Ipa, INC.2002No prior authorization
Ks Plan Administrators, LLC2000No prior authorization
Carepartners Of Connecticut, INC.2000No prior authorization
Beshp, INC.2000No prior authorization
Wellpoint Iowa, INC.2002No prior authorization
Commonwealth Care Alliance, INC.2000No prior authorization
Wellpoint Washington, INC.2002No prior authorization
Neighborhood Health Plan Of Rhode Island2000No prior authorization
Partners Insurance Company Of New Jersey INC2002No prior authorization
Sanford Health Plan Of Minnesota2000No prior authorization
Tufts Health Public Plans, INC.2000No prior authorization
Senior Whole Health Of New York, INC.2000No prior authorization
Nextblue Of North Dakota Insurance Company2002No prior authorization
Healthpartners Insurance Company2002No prior authorization
Missouri Care, Incorporated2002No prior authorization
Memorial Hermann Health Plan2002No prior authorization
Good Samaritan Insurance Plan Of Nebraska, INC.2000No prior authorization
Excellus Health Plan Community Care LLC2000No prior authorization
Trinity Health Plan Of Michigan INC2000No prior authorization
Wyoblue Advantage INC2002No prior authorization
Mount Carmel Health Plan Of New York, INC.2000No prior authorization
Hm Health Insurance Company2002No prior authorization
Horizon Insurance Company2002No prior authorization
Johns Hopkins Health Plan Of Virginia, INC.1000No prior authorization
Community Care Health Plan, INC.1000No prior authorization
Itasca Medical Care1000No prior authorization
HMO Minnesota1001No prior authorization
Wellpoint South Carolina, INC.1001No prior authorization
Connecticare Insurance Company, INC.1000No prior authorization
Provider Partners Health Plan Of Illinois1000No prior authorization
Ghs Health Maintenance Organization, INC.1001No prior authorization
Provider Partners Health Plan Of Texas, INC.1000No prior authorization
Paramount Insurance Company1000No prior authorization
Mcs Advantage, INC.1000No prior authorization
Health Choice Arizona, INC.1000No prior authorization
Alohacare1000No prior authorization
Provider Partners Health Plan Of Kentucky1000No prior authorization
Horizon Healthcare Of New Jersey, INC.1001No prior authorization
Hawaii Medical Service Association (Hmsa)1000No prior authorization
Ventura County Medi-Cal Managed Care Commission1001No prior authorization
Healthfirst Insurance Company, INC.1000No prior authorization

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