Benefily

Does Medicare Part D cover Trelstar?

Trelstar appears on the Medicare Part D formularies of 236 payers in the corpus, across 2,610 plans. 190 payers require prior authorization on every covering plan, 1 on some plans, and 45 on none.

Beyond prior authorization: 104 covering plans require step therapy (another drug tried first) and 383 apply a quantity limit, on at least one Trelstar 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
Humana71571500Prior authorization required
Blue Cross Blue Shield (affiliate)1991039699Varies by plan
Cigna17117100Prior authorization required
Kaiser Permanente115000No prior authorization
SCAN Health Plan747400Prior authorization required
Alignment Healthcare676700Prior authorization required
Elevance Health (Anthem)525200Prior authorization required
Simply Healthcare Plans, INC.505000Prior authorization required
Cariten Health Plan INC.444400Prior authorization required
Priority Health373700Prior authorization required
Careplus Health Plans, INC.363600Prior authorization required
Bravo Health Pennsylvania, INC.353500Prior authorization required
Health Care Service Corporation313100Prior authorization required
Solis Health Plans, INC.242400Prior authorization required
Freedom Health, INC.242400Prior authorization required
Triple S Advantage, INC.222200Prior authorization required
Mmm Healthcare, LLC202000Prior authorization required
Mcs Advantage, INC.2020020Prior authorization required
Hcsc Insurance Services Company181800Prior authorization required
Medica Health Plans171700Prior authorization required
Upmc Health Plan, INC.1717017Prior authorization required
Bluecross Blueshield Of Tennessee, INC.171700Prior authorization required
Wellpoint Texas, INC.161600Prior authorization required
Ultimate Health Plans, INC.1616016Prior authorization required
Excellus Health Plan, INC.161600Prior authorization required
Medical Mutual Of Ohio161600Prior authorization required
Optimum Healthcare, INC.151500Prior authorization required
Selecthealth, INC.141400Prior authorization required
Wellpoint Insurance Company141400Prior authorization required
Healthsun Health Plans, INC.131300Prior authorization required
Prominence Healthfirst Of Texas130013No prior authorization
Atrio Health Plans121200Prior authorization required
Upmc Health Network, INC.1212012Prior authorization required
HMO Louisiana, INC.121200Prior authorization required
Pacificsource Community Health Plans111100Prior authorization required
Community Insurance Company101000Prior authorization required
Health Insurance Plan Of Greater New York101000Prior authorization required
HMO Colorado, INC.101000Prior authorization required
Quartz Health Plan Corporation1010010Prior authorization required
Compcare Health Services Insurance Corporation101000Prior authorization required
Sanford Health Plan9909Prior authorization required
Geisinger Health Plan9009No prior authorization
Doctors Healthcare Plans, INC.9909Prior authorization required
Healthier New Jersey Insurance Company8800Prior authorization required
Healthpartners, INC.8800Prior authorization required
Keystone Health Plan East, INC.8800Prior authorization required
Network Health Insurance Corporation8800Prior authorization required
Prominence Healthfirst8008No prior authorization
Peak Health Insurance Corporation8008No prior authorization
Wellpoint Health Plans, INC.7700Prior authorization required
Astiva Health, INC.7700Prior authorization required
Bravo Health Mid-Atlantic, INC.7700Prior authorization required
Health Alliance Plan Of Michigan7700Prior authorization required
Medica Insurance Company7700Prior authorization required
Summacare INC.7700Prior authorization required
Champion Health Plan Of California INC7700Prior authorization required
Essence Healthcare PPO, INC.7700Prior authorization required
Champion Health Plan Of Nevada, INC.7700Prior authorization required
Bluecross And Blueshield Of South Carolina7707Prior authorization required
Alterwood Advantage, INC.7700Prior authorization required
Mass General Brigham Health Plan, INC6600Prior authorization required
Gold Kidney Of Florida INC6600Prior authorization required
Essence Healthcare, INC.6600Prior authorization required
Hometown Health Plan, INC.6606Prior authorization required
Perennial Advantage Of Colorado, INC.6006No prior authorization
Globalhealth, INC.6600Prior authorization required
Scott And White Health Plan6600Prior authorization required
Chinese Community Health Plan5500Prior authorization required
Alliance Health And Life Insurance Company5500Prior authorization required
Sapphire Edge, INC.5500Prior authorization required
Independent Health Association, INC.5050No prior authorization
Aetna (CVS Health)5005No prior authorization
Oh Chs Snp INC.5500Prior authorization required
Gold Kidney Of Arizona5500Prior authorization required
Wellpoint Tennessee, INC.5500Prior authorization required
Prominence Healthfirst Of Florida INC5005No prior authorization
Priority Health Choice, INC.5500Prior authorization required
Baylor Scott & White Insurance Company4400Prior authorization required
Care N' Care Insurance Company Of North Carolina4404Prior authorization required
The Health Plan Of West Virginia, INC.4400Prior authorization required
Communitycare Government Programs, INC.4004No prior authorization
Qcc Insurance Company4400Prior authorization required
Leon Health, INC.4400Prior authorization required
Verda Health Plan Of Texas INC4400Prior authorization required
Security Health Plan Of Wisconsin, INC.4404Prior authorization required
Gateway Health Plan, INC.4404Prior authorization required
Capital Health Plan4400Prior authorization required
Boston Medical Center Health Plan, INC.4400Prior authorization required
Bluecross Blueshield Kansas Solutions, INC.4400Prior authorization required
Ghs Insurance Company4400Prior authorization required
Thp Insurance Company4400Prior authorization required
Aspire Health Plan4400Prior authorization required
Amh Health, LLC4400Prior authorization required
Dean Health Plan, INC.4004No prior authorization
Health Partners Plans, INC.4400Prior authorization required
Quartz Health Plan Mn Corporation4404Prior authorization required
Medisun, INC.3303Prior authorization required
Louisiana Health Service & Indemnity Company3300Prior authorization required
Eternalhealth, INC.3303Prior authorization required
Patrius Health, INC.3300Prior authorization required
Marquis Advantage, INC.3003No prior authorization
Community Care Health Plan Of Louisiana, INC.3300Prior authorization required
Village Senior Services Corporation3300Prior authorization required
Baycare Select Health Plans, INC.3300Prior authorization required
Cox Health Systems HMO INC3300Prior authorization required
Secur INC3303Prior authorization required
Wellpoint New Jersey, INC.3300Prior authorization required
Volunteer State Health Plan3300Prior authorization required
Align Senior Care California INC.3003No prior authorization
Pruitthealth Premier, INC.3003No prior authorization
Capital District Physicians' Health Plan, INC.3300Prior authorization required
Procare Advantage, LLC3003No prior authorization
Eternalhealth Of Arizona INC3303Prior authorization required
Aultcare Health Insuring Corporation3000No prior authorization
Geisinger Indemnity Insurance Company3003No prior authorization
Simpra Advantage, INC.3003No prior authorization
Provider Partners Health Plan Of Pennsylvania, INC3303Prior authorization required
Provider Partners Health Plan Of North Carolina3303Prior authorization required
Provider Partners Health Plan Of Indiana3303Prior authorization required
Amerihealth Insurance Company Of New Jersey3300Prior authorization required
Vns Choice3300Prior authorization required
Mclaren Health Plan, INC.3300Prior authorization required
Liberty Advantage, LLC3003No prior authorization
Southeastern Indiana Health Organization, INC.3300Prior authorization required
Central Mass Health, LLC3300Prior authorization required
Perennial Advantage Of Ohio, INC.3003No prior authorization
Provider Partners Health Plan Of Missouri, INC.3303Prior authorization required
Medco Containment Life & Medco Containment Ny & Health Care3300Prior authorization required
Hamaspik, INC.2200Prior authorization required
Ks Plan Administrators, LLC2202Prior authorization required
Amerihealth Caritas Vip Next, INC.2200Prior authorization required
Beshp, INC.2202Prior authorization required
Wellpoint Iowa, INC.2200Prior authorization required
Florida Blue Medicare, INC.2000No prior authorization
Wellpoint West Virginia , INC.2200Prior authorization required
Arkansas Superior Select, INC.2200Prior authorization required
Partners Insurance Company INC2200Prior authorization required
Wellpoint Washington, INC.2200Prior authorization required
Lifeworks Advantage, LLC2002No prior authorization
Kansas Superior Select, INC.2002No prior authorization
Signature Advantage, LLC2200Prior authorization required
Primewest Rural Mn Health Care Access Initiative2200Prior authorization required
South Country Health Alliance2200Prior authorization required
Verda Health Plan Of Arizona, INC.2200Prior authorization required
Sanford Health Plan Of Minnesota2202Prior authorization required
Capital Advantage Insurance Company2200Prior authorization required
Keystone Health Plan Central, INC.2200Prior authorization required
Nhc Advantage, LLC2002No prior authorization
Vista Health Plan, INC.2200Prior authorization required
American Health Plan Of Ut, INC.2002No prior authorization
Upmc For You, INC2202Prior authorization required
American Health Plan Of Missouri, INC.2002No prior authorization
New Century Health Plan, INC.2200Prior authorization required
Troy Health, INC.2200Prior authorization required
Community Health Group2200Prior authorization required
Banner - University Care Advantage2200Prior authorization required
Texas Independence Health Plan, INC.2200Prior authorization required
Imperial Health Plan Of California, INC.2200Prior authorization required
Denver Health Medical Plan, INC.2200Prior authorization required
Community Health Plan Of Washington2200Prior authorization required
Healthpartners Insurance Company2200Prior authorization required
Missouri Care, Incorporated2200Prior authorization required
Pruitthealth Premier North Carolina, LLC2002No prior authorization
Elite Health Plan, INC.2200Prior authorization required
American Health Plan Of Iowa INC2002No prior authorization
Elderserve Health, INC.2200Prior authorization required
Align Senior Care Mi, LLC2002No prior authorization
Isnp Ventures, LLC2002No prior authorization
Memorial Hermann Health Plan2200Prior authorization required
Good Samaritan Insurance Plan Of Nebraska, INC.2202Prior authorization required
Excellus Health Plan Community Care LLC2200Prior authorization required
Group Health Cooperative Of Eau Claire2200Prior authorization required
Georgia Assurance, INC.2002No prior authorization
Caresource Georgia CO.2200Prior authorization required
Visiting Nurse Association Of Central New York2200Prior authorization required
Community Health Choice Texas, INC.2002No prior authorization
Align Senior Care Florida, INC.2002No prior authorization
Longevity Health Plan Of New Jersey Insurance Comp2200Prior authorization required
Hm Health Insurance Company2022No prior authorization
Longevity Health Plan Of Colorado, INC.1100Prior authorization required
Tsg Guard, INC.1100Prior authorization required
Local Initiative Health Authority For La County1001No prior authorization
Longevity Health Plan Of Florida, INC.1100Prior authorization required
Imperial County Local Health Authority1100Prior authorization required
Community Care Health Plan, INC.1000No prior authorization
Alameda Alliance For Health1100Prior authorization required
Independent Care Health Plan1100Prior authorization required
HMO Minnesota1100Prior authorization required
Amerihealth Caritas Louisiana, INC.1100Prior authorization required
Partners Insurance Company Of New Jersey INC1100Prior authorization required
Upper Peninsula Health Plan, LLC1100Prior authorization required
Independent Health Benefits Corporation1010No prior authorization
Oklahoma Superior Select, INC.1001No prior authorization
Provider Partners Health Plan Of Illinois1101Prior authorization required
Allcare Health Plan, INC.1100Prior authorization required
Samaritan Health Plans, INC.1101Prior authorization required
Ghs Health Maintenance Organization, INC.1100Prior authorization required
Santa Clara County Health Authority1100Prior authorization required
Provider Partners Health Plan Of Texas, INC.1101Prior authorization required
Kern Health Systems1100Prior 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
Longevity Health Plan Of North Carolina, INC.1100Prior authorization required
Orange County Health Authority1100Prior authorization required
Santa Cruz Monterey Merced San Benito Mariposa Managed Medic1100Prior authorization required
San Joaquin County Health Commission1100Prior authorization required
Banner Health Plan, INC.1100Prior authorization required
Aids Healthcare Foundation1100Prior authorization required
Health Plan Of Careoregon, INC.1100Prior authorization required
Alohacare1101Prior 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 Company1001No prior authorization
American Health Plan Of Fl, INC.1001No prior authorization
Upmc Health Coverage, INC.1101Prior authorization required
Provider Partners Health Plan Of Kentucky1101Prior authorization required
Longevity Health Plan Of Michigan, INC.1100Prior authorization required
Santa Barbara San Luis Obispo Regional Health Authority Dba1100Prior authorization required
American Health Plan, INC.1001No prior authorization
San Francisco Health Authority Dba San Francisco Health Plan1100Prior 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 Corporation1001No prior authorization
Healthy Mississippi, INC.1100Prior authorization required
Inland Empire Health Plan1100Prior authorization required
West Virginia Senior Advantage, INC.1100Prior 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 INC1001No prior authorization
American Health Plan Of Ms, INC.1001No prior authorization
American Health Plan Of Pennsylvania INC1001No prior authorization
Horizon Insurance Company1100Prior authorization required

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