Does American Progressive Life & Hlth Ins Company Of Ny require prior authorization for Rybelsus?
American Progressive Life & Hlth Ins Company Of Ny requires prior authorization for Rybelsus 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 |
|---|---|---|---|---|---|
| semaglutide 14 MG Oral Tablet [Rybelsus]2200650 | 8 / 8 | 8 | 0 | 8 | Prior authorization required |
| semaglutide 3 MG Oral Tablet [Rybelsus]2200654 | 8 / 8 | 8 | 0 | 8 | Prior authorization required |
| semaglutide 7 MG Oral Tablet [Rybelsus]2200658 | 8 / 8 | 8 | 0 | 8 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — semaglutide 14 MG Oral Tablet [Rybelsus]
Rybelsus has 3 products in the corpus; this table is for semaglutide 14 MG Oral Tablet [Rybelsus], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Wellcare Assist Open (PPO) | H2775-113 | 3 | Yes | No | Yes |
| Wellcare Dual Access Open (PPO D-SNP) | H2775-112 | 3 | Yes | No | Yes |
| Wellcare Dual Access Open (PPO D-SNP) | H2775-115 | 3 | Yes | No | Yes |
| Wellcare Giveback Open (PPO) | H2775-111 | 3 | Yes | No | Yes |
| Wellcare Low Premium Open (PPO) | H2775-109 | 3 | Yes | No | Yes |
| Wellcare Premium Enhanced (PFFS) | H2816-019 | 3 | Yes | No | Yes |
| Wellcare Premium Ultra (PFFS) | H2816-013 | 3 | Yes | No | Yes |
| Wellcare Simple Open (PPO) | H2775-106 | 3 | Yes | No | Yes |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
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Rybelsus 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.