Benefily
Prior authorization required

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

Aetna (CVS Health) requires prior authorization for Intralipid 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 productPlans coveringRequire prior authStep therapyQty limitStatus
250 ML soybean oil 200 MG/ML Injection [Intralipid]179970617 / 6581700Prior authorization required
soybean oil 300 MG/ML Injectable Suspension [Intralipid]80513117 / 6581700Prior authorization required

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

Plan-by-plan detail — 250 ML soybean oil 200 MG/ML Injection [Intralipid]

Intralipid has 2 products in the corpus; this table is for 250 ML soybean oil 200 MG/ML Injection [Intralipid], the one carried on the most plans. The product table above covers every strength.

PlanContractTierPrior authStep therapyQty limit
Health First Classic H1099-001 (HMO-POS)H1099-0014YesNoNo
Health First Complete Care H1099-023 (HMO)H1099-0234YesNoNo
Health First Emerald Plus H1099-024 (HMO)H1099-0244YesNoNo
Health First Emerald Plus H1099-026 (HMO)H1099-0264YesNoNo
Health First Emerald Plus H1099-028 (HMO)H1099-0284YesNoNo
Health First Premier Access H1099-025 (HMO-POS)H1099-0254YesNoNo
Health First Premier Access H1099-027 (HMO-POS)H1099-0274YesNoNo
Health First Rewards H1099-014 (HMO)H1099-0144YesNoNo
Health First SunSaver H1099-016 (HMO)H1099-0164YesNoNo
Health First Value H1099-006 (HMO)H1099-0064YesNoNo
Healthfirst 65 Plus Plan (HMO)H3359-0014YesNoNo
Healthfirst CompleteCare (HMO D-SNP)H3359-0341YesNoNo
Healthfirst Connection Plan (HMO D-SNP)H3359-0384YesNoNo
Healthfirst Increased Benefits Plan (HMO)H3359-0194YesNoNo
Healthfirst Life Improvement Plan (HMO D-SNP)H3359-0214YesNoNo
Healthfirst Signature (HMO)H1722-0024YesNoNo
Healthfirst Signature (HMO)H5989-0114YesNoNo
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.

Intralipid at other payers

Or see Intralipid 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.