Benefily

Does Medicare Part D cover Retacrit?

Retacrit appears on the Medicare Part D formularies of 251 payers in the corpus, across 2,939 plans. 248 payers require prior authorization on every covering plan, 0 on some plans, and 3 on none.

Beyond prior authorization: 0 covering plans require step therapy (another drug tried first) and 1,333 apply a quantity limit, on at least one Retacrit 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
Humana8178170817Prior authorization required
Centene (WellCare)19719700Prior authorization required
Blue Cross Blue Shield (affiliate)188188015Prior authorization required
Cigna17117100Prior authorization required
SCAN Health Plan747400Prior authorization required
Alignment Healthcare676700Prior authorization required
Medco Containment Life And Medco Containment Ny606000Prior authorization required
Simply Healthcare Plans, INC.5050050Prior authorization required
Cariten Health Plan INC.4444044Prior authorization required
Priority Health373700Prior authorization required
Careplus Health Plans, INC.3636036Prior authorization required
Bravo Health Pennsylvania, INC.353500Prior authorization required
Health Care Service Corporation313100Prior authorization required
Solis Health Plans, INC.242400Prior authorization required
Sunshine State Health Plan, INC.242400Prior authorization required
Freedom Health, INC.2424024Prior authorization required
Capital Advantage Insurance Company232300Prior authorization required
Triple S Advantage, INC.222200Prior authorization required
Tufts Associated Health Maintenance Organization21000No prior authorization
Mmm Healthcare, LLC202000Prior authorization required
Mcs Advantage, INC.2020020Prior authorization required
Harmony Health Plan, INC.191900Prior authorization required
Hcsc Insurance Services Company181800Prior authorization required
California Physicians' Service171700Prior authorization required
Medica Health Plans171700Prior authorization required
Upmc Health Plan, INC.171700Prior authorization required
Ultimate Health Plans, INC.161600Prior authorization required
Excellus Health Plan, INC.161600Prior authorization required
Medical Mutual Of Ohio161600Prior authorization required
Superior Healthplan, INC.151500Prior authorization required
Florida Blue Medicare, INC.151502Prior authorization required
Optimum Healthcare, INC.1515015Prior authorization required
Selecthealth, INC.141400Prior authorization required
Healthsun Health Plans, INC.1313013Prior authorization required
Prominence Healthfirst Of Texas1313013Prior authorization required
Atrio Health Plans1212012Prior authorization required
Upmc Health Network, INC.121200Prior authorization required
HMO Louisiana, INC.121200Prior authorization required
Health Insurance Plan Of Greater New York101000Prior authorization required
Quartz Health Plan Corporation101000Prior authorization required
Sanford Health Plan9900Prior authorization required
Geisinger Health Plan9909Prior authorization required
Doctors Healthcare Plans, INC.9909Prior authorization required
New York Quality Healthcare Corporation9900Prior authorization required
Healthier New Jersey Insurance Company8800Prior authorization required
Meridian Health Plan Of Michigan, INC.8800Prior authorization required
Healthpartners, INC.8800Prior authorization required
American Progressive Life & Hlth Ins Company Of Ny8800Prior authorization required
Keystone Health Plan East, INC.8800Prior authorization required
Network Health Insurance Corporation8800Prior authorization required
Prominence Healthfirst8808Prior authorization required
Fallon Community Health Plan8800Prior authorization required
Peak Health Insurance Corporation8808Prior authorization required
Health Partners Plans, INC.8800Prior authorization required
Medco Containment Life & Medco Containment Ny & Health Care8800Prior authorization required
Astiva Health, INC.7707Prior authorization required
Bravo Health Mid-Atlantic, INC.7700Prior authorization required
Medica Insurance Company7700Prior authorization required
Summacare INC.7707Prior authorization required
Keystone Health Plan Central, INC.7700Prior authorization required
Champion Health Plan Of California INC7707Prior authorization required
Essence Healthcare PPO, INC.7700Prior authorization required
Champion Health Plan Of Nevada, INC.7707Prior authorization required
Providence Health Assurance7700Prior authorization required
Alterwood Advantage, INC.7707Prior authorization required
Mass General Brigham Health Plan, INC6600Prior authorization required
Buckeye Community Health Plan, INC.6600Prior authorization required
Nebraska Total Care, INC.6600Prior authorization required
Wellpoint Health Plans, INC.6606Prior authorization required
Gold Kidney Of Florida INC6606Prior authorization required
Essence Healthcare, INC.6600Prior authorization required
Hometown Health Plan, INC.6600Prior authorization required
Presbyterian Health Plan6606Prior authorization required
Perennial Advantage Of Colorado, INC.6606Prior authorization required
Globalhealth, INC.6606Prior authorization required
Bluecross And Blueshield Of South Carolina6600Prior authorization required
Scott And White Health Plan6600Prior authorization required
Coordinated Care Of Washington, INC.5500Prior authorization required
Chinese Community Health Plan5505Prior authorization required
Wellpoint Texas, INC.5505Prior authorization required
Sapphire Edge, INC.5500Prior authorization required
Independent Health Association, INC.5500Prior authorization required
Aetna (CVS Health)5505Prior authorization required
Coordinated Care Corporation5500Prior authorization required
Oh Chs Snp INC.5505Prior authorization required
HMO Colorado, INC.5505Prior authorization required
Gold Kidney Of Arizona5505Prior authorization required
Meridian Health Plan Of Illinois, INC.5500Prior authorization required
Sunflower State Health Plan, INC.5500Prior authorization required
Prominence Healthfirst Of Florida INC5505Prior authorization required
Priority Health Choice, INC.5500Prior authorization required
Arkansas Health & Wellness Health Plan, INC.5500Prior authorization required
Home State Health Plan, INC.4400Prior authorization required
Baylor Scott & White Insurance Company4400Prior authorization required
Care N' Care Insurance Company Of North Carolina4400Prior authorization required
Health New England, INC.4400Prior authorization required
Pennsylvania Health & Wellness, INC.4400Prior authorization required
The Health Plan Of West Virginia, INC.4400Prior authorization required
Communitycare Government Programs, INC.4404Prior authorization required
Qcc Insurance Company4400Prior authorization required
Leon Health, INC.4404Prior authorization required
Verda Health Plan Of Texas INC4404Prior authorization required
Security Health Plan Of Wisconsin, INC.4400Prior authorization required
Gateway Health Plan, INC.4400Prior authorization required
Capital Health Plan4400Prior authorization required
Boston Medical Center Health Plan, INC.4400Prior authorization required
Bluecross Blueshield Kansas Solutions, INC.4400Prior authorization required
Central Mass Health, LLC4400Prior authorization required
Ghs Insurance Company4400Prior authorization required
Thp Insurance Company4400Prior authorization required
Aspire Health Plan4404Prior authorization required
Dean Health Plan, INC.4404Prior authorization required
Quartz Health Plan Mn Corporation4400Prior authorization required
Medisun, INC.3300Prior authorization required
Louisiana Health Service & Indemnity Company3300Prior authorization required
Eternalhealth, INC.3300Prior authorization required
Patrius Health, INC.3300Prior authorization required
Marquis Advantage, INC.3303Prior authorization required
Partners Insurance Company INC3300Prior authorization required
Village Senior Services Corporation3303Prior authorization required
Trillium Community Health Plan, INC.3300Prior authorization required
Baycare Select Health Plans, INC.3303Prior authorization required
Cox Health Systems HMO INC3303Prior authorization required
Secur INC3303Prior authorization required
Align Senior Care California INC.3303Prior authorization required
Pruitthealth Premier, INC.3303Prior authorization required
Capital District Physicians' Health Plan, INC.3300Prior authorization required
Procare Advantage, LLC3303Prior authorization required
Eternalhealth Of Arizona INC3300Prior authorization required
Aultcare Health Insuring Corporation3300Prior authorization required
Geisinger Indemnity Insurance Company3303Prior authorization required
Simpra Advantage, INC.3303Prior authorization required
Provider Partners Health Plan Of Pennsylvania, INC3300Prior authorization required
Provider Partners Health Plan Of North Carolina3300Prior authorization required
Provider Partners Health Plan Of Indiana3300Prior authorization required
Celtic Insurance Company3300Prior authorization required
Amerihealth Insurance Company Of New Jersey3300Prior authorization required
Vns Choice3303Prior authorization required
Mclaren Health Plan, INC.3303Prior authorization required
Liberty Advantage, LLC3303Prior authorization required
Southeastern Indiana Health Organization, INC.3303Prior authorization required
Managed Health Services Insurance CORP.3300Prior authorization required
Perennial Advantage Of Ohio, INC.3303Prior authorization required
Wellpoint Insurance Company3303Prior authorization required
Provider Partners Health Plan Of Missouri, INC.3300Prior authorization required
Hamaspik, INC.2200Prior authorization required
Ks Plan Administrators, LLC2200Prior authorization required
Carepartners Of Connecticut, INC.2000No prior authorization
Amerihealth Caritas Vip Next, INC.2200Prior authorization required
Beshp, INC.2200Prior authorization required
Arkansas Superior Select, INC.2202Prior authorization required
Lifeworks Advantage, LLC2202Prior authorization required
Kansas Superior Select, INC.2202Prior authorization required
Signature Advantage, LLC2202Prior authorization required
Primewest Rural Mn Health Care Access Initiative2202Prior authorization required
South Country Health Alliance2200Prior authorization required
Sentara Health Plans2200Prior authorization required
Verda Health Plan Of Arizona, INC.2202Prior authorization required
Partners Insurance Company Of New Jersey INC2200Prior authorization required
Sanford Health Plan Of Minnesota2200Prior authorization required
Nhc Advantage, LLC2202Prior authorization required
Vista Health Plan, INC.2200Prior authorization required
American Health Plan Of Ut, INC.2202Prior authorization required
Upmc For You, INC2200Prior authorization required
American Health Plan Of Missouri, INC.2202Prior authorization required
Selectcare Of Texas, INC.2200Prior authorization required
New Century Health Plan, INC.2202Prior authorization required
Troy Health, INC.2200Prior authorization required
Community Health Group2202Prior authorization required
Banner - University Care Advantage2200Prior authorization required
Texas Independence Health Plan, INC.2202Prior authorization required
Tufts Health Public Plans, INC.2000No prior authorization
Imperial Health Plan Of California, INC.2202Prior authorization required
Bridgeway Health Solutions Of Arizona, INC.2200Prior authorization required
Denver Health Medical Plan, INC.2202Prior authorization required
Community Health Plan Of Washington2200Prior authorization required
Healthpartners Insurance Company2200Prior authorization required
Pruitthealth Premier North Carolina, LLC2202Prior authorization required
Elite Health Plan, INC.2202Prior authorization required
American Health Plan Of Iowa INC2202Prior authorization required
Elderserve Health, INC.2200Prior authorization required
Align Senior Care Mi, LLC2202Prior authorization required
Isnp Ventures, LLC2202Prior authorization required
Memorial Hermann Health Plan2200Prior authorization required
Good Samaritan Insurance Plan Of Nebraska, INC.2200Prior authorization required
Excellus Health Plan Community Care LLC2200Prior authorization required
Group Health Cooperative Of Eau Claire2200Prior authorization required
Georgia Assurance, INC.2202Prior authorization required
Caresource Georgia CO.2200Prior authorization required
Visiting Nurse Association Of Central New York2202Prior authorization required
Community Health Choice Texas, INC.2202Prior authorization required
Align Senior Care Florida, INC.2202Prior authorization required
Longevity Health Plan Of New Jersey Insurance Comp2200Prior authorization required
Hm Health Insurance Company2200Prior authorization required
Horizon Insurance Company2200Prior authorization required
Longevity Health Plan Of Colorado, INC.1100Prior authorization required
Tsg Guard, INC.1101Prior authorization required
Local Initiative Health Authority For La County1101Prior authorization required
Longevity Health Plan Of Florida, INC.1100Prior authorization required
Imperial County Local Health Authority1101Prior authorization required
Community Care Health Plan, INC.1100Prior authorization required
Alameda Alliance For Health1100Prior authorization required
Independent Care Health Plan1101Prior authorization required
HMO Minnesota1100Prior authorization required
Amerihealth Caritas Louisiana, INC.1100Prior authorization required
Upper Peninsula Health Plan, LLC1100Prior authorization required
Independent Health Benefits Corporation1100Prior authorization required
Elevance Health (Anthem)1101Prior authorization required
Oklahoma Superior Select, INC.1101Prior authorization required
Provider Partners Health Plan Of Illinois1100Prior authorization required
Allcare Health Plan, INC.1101Prior authorization required
Ghs Health Maintenance Organization, INC.1100Prior authorization required
Santa Clara County Health Authority1101Prior authorization required
Provider Partners Health Plan Of Texas, INC.1100Prior authorization required
Kern Health Systems1101Prior authorization required
Hap Caresource1100Prior authorization required
Select Health Of South Carolina, INC.1100Prior authorization required
Contra Costa County Medical Service Dba Contra Costa Health1100Prior authorization required
Absolute Total Care, INC.1100Prior authorization required
Longevity Health Plan Of North Carolina, INC.1100Prior authorization required
Orange County Health Authority1100Prior authorization required
Santa Cruz Monterey Merced San Benito Mariposa Managed Medic1101Prior authorization required
San Joaquin County Health Commission1101Prior authorization required
Banner Health Plan, INC.1100Prior authorization required
Aids Healthcare Foundation1101Prior authorization required
Health Plan Of Careoregon, INC.1100Prior authorization required
Alohacare1100Prior authorization required
San Mateo Health Commission1101Prior authorization required
Amerihealth Michigan, INC.1100Prior authorization required
Amerihealth Caritas Florida, INC.1100Prior authorization required
Caresource Ohio, INC.1100Prior authorization required
Lagniappe Advantage Insurance Company1101Prior authorization required
American Health Plan Of Fl, INC.1101Prior authorization required
Upmc Health Coverage, INC.1100Prior authorization required
Provider Partners Health Plan Of Kentucky1100Prior authorization required
Longevity Health Plan Of Michigan, INC.1100Prior authorization required
Santa Barbara San Luis Obispo Regional Health Authority Dba1101Prior authorization required
American Health Plan, INC.1101Prior authorization required
San Francisco Health Authority Dba San Francisco Health Plan1101Prior authorization required
Amerihealth Caritas North Carolina, INC.1100Prior authorization required
Horizon Healthcare Of New Jersey, INC.1100Prior authorization required
Longevity Health Plan Of New York, INC.1100Prior authorization required
Dignity Care Corporation1101Prior authorization required
Healthy Mississippi, INC.1100Prior authorization required
Inland Empire Health Plan1101Prior authorization required
West Virginia Senior Advantage, INC.1101Prior authorization required
Longevity Health Plan Of Illinois, INC.1100Prior authorization required
Ventura County Medi-Cal Managed Care Commission1100Prior authorization required
American Health Plan Of Indiana INC1101Prior authorization required
American Health Plan Of Ms, INC.1101Prior authorization required
American Health Plan Of Pennsylvania INC1101Prior authorization required

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