Prior authorization required
Does Aetna (CVS Health) require prior authorization for Inqovi 5 Tablet Pack?
Aetna (CVS Health) requires prior authorization for Inqovi 5 Tablet Pack on every Medicare Part D plan of theirs that covers it.
Every plan from this payer that covers the drug requires authorization before it is dispensed.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| {5 (cedazuridine 100 MG / decitabine 35 MG Oral Tablet [Inqovi]) } Pack [Inqovi 5 Tablet Pack]2384465 | 658 / 658 | 658 | 0 | 648 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — {5 (cedazuridine 100 MG / decitabine 35 MG Oral Tablet [Inqovi]) } Pack [Inqovi 5 Tablet Pack]
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Aetna Community HealthChoices (HMO D-SNP) | H3959-069 | 5 | Yes | No | Yes |
| Aetna Community HealthChoices (HMO D-SNP) | H3959-070 | 5 | Yes | No | Yes |
| Aetna Community HealthChoices (HMO D-SNP) | H3959-071 | 5 | Yes | No | Yes |
| Aetna Community HealthChoices (HMO D-SNP) | H3959-072 | 5 | Yes | No | Yes |
| Aetna Community HealthChoices (HMO D-SNP) | H3959-073 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra (PPO) | H1608-029 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra (PPO) | H7301-002 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Dual (HMO D-SNP) | H1692-005 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Dual (HMO D-SNP) | H3959-036 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Dual Care (HMO D-SNP) | H3959-035 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Elite (HMO) | H1692-003 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Enhanced (HMO-POS) | H3959-001 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Enhanced (HMO-POS) | H3959-039 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Enhanced (PPO) | H1608-027 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Extra (PPO) | H7301-006 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Premier (HMO-POS) | H3959-002 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Premier (PPO) | H5522-002 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Premier (PPO) | H5522-014 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Prime Plus (HMO-POS) | H3959-053 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature (HMO-POS) | H3959-010 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature (HMO-POS) | H3959-037 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature (HMO-POS) | H3959-052 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature (HMO) | H1692-002 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature (HMO) | H3959-055 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature (PPO) | H1608-040 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature (PPO) | H5522-004 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature Giveback (PPO) | H1608-031 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature Giveback (PPO) | H5522-017 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature Plus (HMO-POS) | H3959-011 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature Plus (HMO-POS) | H3959-032 | 5 | Yes | No | Yes |
| Aetna Medicare Carilion Health Prime (HMO-POS) | H3931-158 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H0628-036 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H0628-037 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H0628-038 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H0628-039 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H1609-080 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H1609-081 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H1609-082 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H1609-083 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H1609-084 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H1609-085 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H1609-094 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H2663-098 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H2663-100 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H2663-102 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H3146-037 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H3146-038 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H3192-033 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H3239-030 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H3312-091 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H3931-191 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H3959-076 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H3959-084 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H5302-026 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (PPO C-SNP) | H2293-035 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | H0628-031 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | H0628-032 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | H0628-033 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | H0628-034 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | H0628-035 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | H2663-099 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | H3146-036 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | H3192-028 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | H3192-029 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | H3959-083 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | H3146-044 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | H3959-074 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | H3959-075 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | H3959-085 | 5 | Yes | No | Yes |
| Aetna Medicare Dual (HMO D-SNP) | H3146-002 | 5 | Yes | No | Yes |
| Aetna Medicare Dual (HMO D-SNP) | H4711-013 | 5 | Yes | No | Yes |
| Aetna Medicare Dual (HMO D-SNP) | H5325-004 | 5 | Yes | No | Yes |
| Aetna Medicare Dual (HMO D-SNP) | H5325-005 | 5 | Yes | No | Yes |
| Aetna Medicare Dual (HMO D-SNP) | H5325-006 | 5 | Yes | No | Yes |
| Aetna Medicare Dual (PPO D-SNP) | H1608-062 | 5 | Yes | No | Yes |
| Aetna Medicare Dual (PPO D-SNP) | H1608-077 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H0628-013 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H3239-010 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H3239-012 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H3239-023 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H4711-012 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H5302-020 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H5325-003 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H5593-001 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H7149-006 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H8597-001 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H8597-002 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H8597-003 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (PPO D-SNP) | H2293-004 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (PPO D-SNP) | H3288-053 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (PPO D-SNP) | H5521-465 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (PPO D-SNP) | H5521-472 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Extra (HMO D-SNP) | H3239-005 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Extra (PPO D-SNP) | H1608-076 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Extra (PPO D-SNP) | H2293-021 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Extra Care (HMO D-SNP) | H3239-001 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Extra Care (HMO D-SNP) | H3239-002 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Extra Care (HMO D-SNP) | H3239-007 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Extra Care (HMO D-SNP) | H3239-015 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Extra Care (HMO D-SNP) | H3931-175 | 5 | Yes | No | Yes |
Showing 100 of 658 covering plans.
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.
Inqovi 5 Tablet Pack at other payers
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.