Varies by plan

Does Aetna (CVS Health) require prior authorization for Ingrezza?

Prior authorization for Ingrezza differs across Aetna (CVS Health)'s Medicare Part D plans and product strengths — 5 of 7 Ingrezza products in the corpus appear on their formularies, and the requirement is not uniform. Check the member's specific plan.

Some plans require authorization and others do not. The member's specific plan decides.

This drug does not appear on any of this payer's Medicare Part D formularies. That means it is NOT COVERED under those plans — which is a different and generally worse outcome than requiring prior authorization. An exception or formulary-exception request may still be possible.

By product strength

RxNorm product	Plans covering	Require prior auth	Qty limit	Status
valbenazine 40 MG Oral Capsule [Ingrezza]1918230	15 / 658	15	15	Prior authorization required
valbenazine 80 MG Oral Capsule [Ingrezza]1986331	15 / 658	15	15	Prior authorization required
{7 (valbenazine 40 MG Oral Capsule [Ingrezza]) / 21 (valbenazine 80 MG Oral Capsule [Ingrezza]) } Pack [Ingrezza]2054269	15 / 658	15	15	Prior authorization required
valbenazine 60 MG Oral Capsule [Ingrezza]2541513	15 / 658	15	15	Prior authorization required
Sprinkle valbenazine 40 MG Oral Capsule [Ingrezza]2680780	15 / 658	15	15	Prior authorization required
Sprinkle valbenazine 60 MG Oral Capsule [Ingrezza]2680782	0 / 658	0	0	Not on formulary
Sprinkle valbenazine 80 MG Oral Capsule [Ingrezza]2680784	0 / 658	0	0	Not on formulary

Product names come from RxNorm (U.S. National Library of Medicine).

Plan-by-plan detail — valbenazine 40 MG Oral Capsule [Ingrezza]

Ingrezza has 7 products in the corpus; this table is for valbenazine 40 MG Oral Capsule [Ingrezza], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
Community First Medicare Advantage Alamo Plan (HMO)	H5447-001	5	Yes	No	Yes
Community First Medicare Advantage D-SNP (HMO D-SNP)	H5447-002	5	Yes	No	Yes
El Paso Health Giveback (HMO)	H3407-003	5	Yes	No	Yes
El Paso Health Medicare Advantage Dual (HMO D-SNP)	H3407-001	5	Yes	No	Yes
El Paso Health Total (HMO)	H3407-002	5	Yes	No	Yes
Health First Classic H1099-001 (HMO-POS)	H1099-001	5	Yes	No	Yes
Health First Complete Care H1099-023 (HMO)	H1099-023	5	Yes	No	Yes
Health First Emerald Plus H1099-024 (HMO)	H1099-024	5	Yes	No	Yes
Health First Emerald Plus H1099-026 (HMO)	H1099-026	5	Yes	No	Yes
Health First Emerald Plus H1099-028 (HMO)	H1099-028	5	Yes	No	Yes
Health First Premier Access H1099-025 (HMO-POS)	H1099-025	5	Yes	No	Yes
Health First Premier Access H1099-027 (HMO-POS)	H1099-027	5	Yes	No	Yes
Health First Rewards H1099-014 (HMO)	H1099-014	5	Yes	No	Yes
Health First SunSaver H1099-016 (HMO)	H1099-016	5	Yes	No	Yes
Health First Value H1099-006 (HMO)	H1099-006	5	Yes	No	Yes

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.

Ingrezza at other payers

Or see Ingrezza across every payer at once.

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.