Varies by plan

Does Alignment Healthcare require prior authorization for Rinvoq?

Prior authorization for Rinvoq differs across Alignment Healthcare's Medicare Part D plans and product strengths — 3 of 4 Rinvoq 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
24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq]2196900	67 / 67	67	67	Prior authorization required
24 HR upadacitinib 30 MG Extended Release Oral Tablet [Rinvoq]2590054	67 / 67	67	67	Prior authorization required
24 HR upadacitinib 45 MG Extended Release Oral Tablet [Rinvoq]2596960	67 / 67	67	67	Prior authorization required
upadacitinib 1 MG/ML Oral Solution [Rinvoq]2681019	0 / 67	0	0	Not on formulary

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

Plan-by-plan detail — 24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq]

Rinvoq has 4 products in the corpus; this table is for 24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
Alignment Health + Intermountain Health (HMO)	H9686-009	5	Yes	No	Yes
Alignment Health Advantage PPO (PPO)	H8832-001	5	Yes	No	Yes
Alignment Health Advantage PPO (PPO)	H8832-002	5	Yes	No	Yes
Alignment Health AllCare Preferred (HMO)	H3815-011	5	Yes	No	Yes
Alignment Health AVA (PPO)	H7074-001	5	Yes	No	Yes
Alignment Health Balance (HMO C-SNP)	H3815-033	5	Yes	No	Yes
Alignment Health Balance (PPO)	H4961-006	5	Yes	No	Yes
Alignment Health BreathEasy (HMO C-SNP)	H3815-041	5	Yes	No	Yes
Alignment Health Clarity (HMO C-SNP)	H3815-042	5	Yes	No	Yes
Alignment Health CommUnity (HMO)	H3815-046	5	Yes	No	Yes
Alignment Health Dual Select+ (HMO-POS D-SNP)	H5472-007	5	Yes	No	Yes
Alignment Health Freedom (PPO)	H8832-003	5	Yes	No	Yes
Alignment Health Harmony (HMO)	H3815-031	5	Yes	No	Yes
Alignment Health Heart & Diabetes (HMO C-SNP)	H3443-003	5	Yes	No	Yes
Alignment Health Heart & Diabetes (HMO C-SNP)	H3815-010	5	Yes	No	Yes
Alignment Health Heart & Diabetes (HMO C-SNP)	H9686-004	5	Yes	No	Yes
Alignment Health Heart & Diabetes (HMO-POS C-SNP)	H5472-002	5	Yes	No	Yes
Alignment Health Heart & Diabetes Access (HMO C-SNP)	H3815-044	5	Yes	No	Yes
Alignment Health Heart & Diabetes AZPlus (HMO C-SNP)	H3443-007	5	Yes	No	Yes
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP)	H3815-039	5	Yes	No	Yes
Alignment Health Heart & Diabetes Care (HMO C-SNP)	H3815-048	5	Yes	No	Yes
Alignment Health Heart & Diabetes Care (HMO C-SNP)	H3815-054	5	Yes	No	Yes
Alignment Health Heart & Diabetes Care (HMO C-SNP)	H5296-011	5	Yes	No	Yes
Alignment Health Heart & Diabetes Choice (HMO C-SNP)	H3815-051	5	Yes	No	Yes
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)	H5296-009	5	Yes	No	Yes
Alignment Health Heart & Diabetes NVPlus (HMO C-SNP)	H9686-006	5	Yes	No	Yes
Alignment Health Heart & Diabetes Plus (HMO C-SNP)	H3443-006	5	Yes	No	Yes
Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP)	H5472-004	5	Yes	No	Yes
Alignment Health Honor+ Plan (HMO)	H3815-052	5	Yes	No	Yes
Alignment Health L.A. Premium Giveback (HMO)	H3815-055	5	Yes	No	Yes
Alignment Health My Choice (HMO)	H3815-001	5	Yes	No	Yes
Alignment Health My Choice (HMO)	H3815-028	5	Yes	No	Yes
Alignment Health My Choice (PPO)	H4961-001	5	Yes	No	Yes
Alignment Health My Choice (PPO)	H4961-003	5	Yes	No	Yes
Alignment Health My Choice CalCare (HMO)	H3815-050	5	Yes	No	Yes
Alignment Health My Choice Select (HMO)	H3815-049	5	Yes	No	Yes
Alignment Health NC Duals (HMO-POS D-SNP)	H5296-004	5	Yes	No	Yes
Alignment Health Platinum (HMO)	H5296-003	5	Yes	No	Yes
Alignment Health Platinum + Instacart (HMO-POS)	H3815-016	5	Yes	No	Yes
Alignment Health Platinum + Instacart (HMO)	H3815-008	5	Yes	No	Yes
Alignment Health Platinum + Instacart (HMO)	H5296-007	5	Yes	No	Yes
Alignment Health Platinum + Instacart (HMO)	H9686-007	5	Yes	No	Yes
Alignment Health Platinum Select (HMO)	H5296-010	5	Yes	No	Yes
Alignment Health S.D. Premium Giveback (HMO)	H3815-056	5	Yes	No	Yes
Alignment Health Silicon (HMO C-SNP)	H3815-045	5	Yes	No	Yes
Alignment Health smartHMO (HMO-POS)	H5472-003	5	Yes	No	Yes
Alignment Health smartHMO (HMO)	H3443-005	5	Yes	No	Yes
Alignment Health smartHMO (HMO)	H3815-013	5	Yes	No	Yes
Alignment Health smartHMO (HMO)	H3815-038	5	Yes	No	Yes
Alignment Health smartHMO (HMO)	H3815-040	5	Yes	No	Yes
Alignment Health smartHMO (HMO)	H5296-006	5	Yes	No	Yes
Alignment Health smartHMO (HMO)	H5296-008	5	Yes	No	Yes
Alignment Health smartHMO (HMO)	H9686-008	5	Yes	No	Yes
Alignment Health smartSavings (HMO-POS)	H5472-010	5	Yes	No	Yes
Alignment Health smartSavings (HMO)	H3815-047	5	Yes	No	Yes
Alignment Health Sutter Advantage +More (HMO)	H3815-019	5	Yes	No	Yes
Alignment Health Sutter Advantage +More (HMO)	H3815-020	5	Yes	No	Yes
Alignment Health Sutter Advantage +More (HMO)	H3815-021	5	Yes	No	Yes
Alignment Health Sutter Advantage +More (HMO)	H3815-023	5	Yes	No	Yes
Alignment Health the ONE (HMO D-SNP)	H9686-005	5	Yes	No	Yes
Alignment Health the ONE (HMO)	H3815-034	5	Yes	No	Yes
Alignment Health the ONE + Walgreens (HMO-POS)	H5472-001	5	Yes	No	Yes
Alignment Health the ONE + Walgreens (HMO)	H3443-001	5	Yes	No	Yes
Alignment Health the ONE + Walgreens (HMO)	H3443-002	5	Yes	No	Yes
Alignment Health the ONE + Walgreens (HMO)	H3815-035	5	Yes	No	Yes
Alignment Health Total Dual+ (HMO-POS D-SNP)	H5472-009	5	Yes	No	Yes
Alignment Health ValorCare (HMO)	H3815-053	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.

Rinvoq at other payers

Or see Rinvoq 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.