Does Aetna (CVS Health) require prior authorization for Retacrit?
Prior authorization for Retacrit differs across Aetna (CVS Health)'s Medicare Part D plans and product strengths — 4 of 7 Retacrit 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 | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| 1 ML epoetin alfa-epbx 10000 UNT/ML Injection [Retacrit]2047596 | 5 / 658 | 5 | 0 | 5 | Prior authorization required |
| 1 ML epoetin alfa-epbx 2000 UNT/ML Injection [Retacrit]2047602 | 5 / 658 | 5 | 0 | 5 | Prior authorization required |
| 1 ML epoetin alfa-epbx 3000 UNT/ML Injection [Retacrit]2047608 | 5 / 658 | 5 | 0 | 5 | Prior authorization required |
| 1 ML epoetin alfa-epbx 4000 UNT/ML Injection [Retacrit]2047614 | 5 / 658 | 5 | 0 | 5 | Prior authorization required |
| 1 ML epoetin alfa-epbx 40000 UNT/ML Injection [Retacrit]2047623 | 0 / 658 | 0 | 0 | 0 | Not on formulary |
| epoetin alfa-epbx 10000 UNT/ML Injectable Solution [Retacrit]2463733 | 0 / 658 | 0 | 0 | 0 | Not on formulary |
| epoetin alfa-epbx 20000 UNT/ML Injectable Solution [Retacrit]2463737 | 0 / 658 | 0 | 0 | 0 | Not on formulary |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — 1 ML epoetin alfa-epbx 10000 UNT/ML Injection [Retacrit]
Retacrit has 7 products in the corpus; this table is for 1 ML epoetin alfa-epbx 10000 UNT/ML Injection [Retacrit], 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 | 3 | Yes | No | Yes |
| Community First Medicare Advantage D-SNP (HMO D-SNP) | H5447-002 | 3 | Yes | No | Yes |
| El Paso Health Giveback (HMO) | H3407-003 | 3 | Yes | No | Yes |
| El Paso Health Medicare Advantage Dual (HMO D-SNP) | H3407-001 | 3 | Yes | No | Yes |
| El Paso Health Total (HMO) | H3407-002 | 3 | Yes | No | Yes |
- 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.
Retacrit 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.