Varies by plan

Does Blue Cross Blue Shield (affiliate) require prior authorization for Amnesteem?

Prior authorization for Amnesteem differs across Blue Cross Blue Shield (affiliate)'s Medicare Part D plans and product strengths — 4 of 4 Amnesteem 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.

Prior authorization requirements differ across this payer's plans: 119 of 269 covering plans require it. Check the specific plan the member is enrolled in — the plan name and contract number are on their insurance card.
Prior authorization requirements differ across this payer's plans: 90 of 237 covering plans require it. Check the specific plan the member is enrolled in — the plan name and contract number are on their insurance card.

By product strength

RxNorm product	Plans covering	Require prior auth	Status
isotretinoin 30 MG Oral Capsule [Amnesteem]2711694	269 / 269	119	Varies by plan
isotretinoin 10 MG Oral Capsule [Amnesteem]404058	269 / 269	119	Varies by plan
isotretinoin 20 MG Oral Capsule [Amnesteem]404061	269 / 269	119	Varies by plan
isotretinoin 40 MG Oral Capsule [Amnesteem]404064	237 / 269	90	Varies by plan

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

Plan-by-plan detail — isotretinoin 30 MG Oral Capsule [Amnesteem]

Amnesteem has 4 products in the corpus; this table is for isotretinoin 30 MG Oral Capsule [Amnesteem], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
Anthem Dual Advantage (HMO D-SNP)	H5422-018	4	No	No	No
Anthem Extra Help (HMO-POS)	H5422-013	4	No	No	No
Anthem Full Dual Advantage (HMO D-SNP)	H5422-019	4	No	No	No
Anthem Full Dual Advantage Aligned (HMO D-SNP)	H4471-010	4	No	No	No
Anthem Full Dual Advantage Aligned (HMO D-SNP)	H4471-010	4	No	No	No
Anthem Full Dual Advantage Aligned (HMO D-SNP)	H4471-011	4	No	No	No
Anthem I CareMore Chronic Care (HMO-POS C-SNP)	H0544-004	4	No	No	No
Anthem I CareMore Chronic Care (HMO-POS C-SNP)	H0544-010	4	No	No	No
Anthem I CareMore Chronic Care 2 (HMO-POS C-SNP)	H4161-014	4	No	No	No
Anthem I CareMore Chronic Care 2 (HMO-POS C-SNP)	H4161-015	4	No	No	No
Anthem I CareMore Home Care (HMO I-SNP)	H0544-005	4	No	No	No
Anthem I CareMore Kidney Care (HMO-POS C-SNP)	H0544-015	4	No	No	No
Anthem I CareMore Kidney Care (HMO-POS C-SNP)	H0544-020	4	No	No	No
Anthem I CareMore Lung Care (HMO-POS C-SNP)	H0544-014	4	No	No	No
Anthem I CareMore Lung Care (HMO-POS C-SNP)	H0544-019	4	No	No	No
Anthem I CareMore Lung Care 2 (HMO-POS C-SNP)	H4161-016	4	No	No	No
Anthem I CareMore Lung Care 2 (HMO-POS C-SNP)	H4161-017	4	No	No	No
Anthem I CareMore Medicare Advantage (HMO-POS)	H4161-011	4	No	No	No
Anthem I CareMore Medicare Advantage (HMO-POS)	H4161-013	4	No	No	No
Anthem I CareMore Medicare Advantage 2 (HMO-POS)	H0544-002	4	No	No	No
Anthem I CareMore Premium Savings (HMO-POS)	H4161-012	4	No	No	No
Anthem Kidney Care (HMO-POS C-SNP)	H5422-015	4	No	No	No
Anthem Medicare Advantage (HMO-POS)	H0544-056	4	No	No	No
Anthem Medicare Advantage (HMO-POS)	H0544-061	4	No	No	No
Anthem Medicare Advantage (HMO-POS)	H0544-062	4	No	No	No
Anthem Medicare Advantage (HMO-POS)	H0544-063	4	No	No	No
Anthem Medicare Advantage (HMO-POS)	H0544-064	4	No	No	No
Anthem Medicare Advantage (HMO-POS)	H0544-065	4	No	No	No
Anthem Medicare Advantage (HMO-POS)	H0544-095	4	No	No	No
Anthem Medicare Advantage (HMO-POS)	H0544-096	4	No	No	No
Anthem Medicare Advantage (HMO-POS)	H0544-108	4	No	No	No
Anthem Medicare Advantage (HMO-POS)	H5422-011	4	No	No	No
Anthem Prime (HMO-POS)	H4161-002	4	No	No	No
Anthem Prime (HMO-POS)	H4161-003	4	No	No	No
Anthem Prime (HMO-POS)	H4161-004	4	No	No	No
Anthem Prime (HMO-POS)	H4161-005	4	No	No	No
Anthem Prime (HMO-POS)	H4161-006	4	No	No	No
Anthem Prime (HMO-POS)	H4161-007	4	No	No	No
Anthem Prime (HMO-POS)	H4161-009	4	No	No	No
Anthem Prime (HMO-POS)	H4161-010	4	No	No	No
Anthem Select (HMO-POS)	H0544-058	4	No	No	No
Anthem Select (HMO-POS)	H0544-066	4	No	No	No
Anthem Select (HMO-POS)	H0544-069	4	No	No	No
Anthem Select (HMO-POS)	H0544-091	4	No	No	No
Anthem Select (HMO-POS)	H0544-098	4	No	No	No
Blue Advantage Choice (PPO)	H0104-016	4	Yes	No	No
Blue Advantage Complete (PPO)	H0104-012	4	Yes	No	No
Blue Advantage Complete (PPO)	H0104-014	4	Yes	No	No
Blue Advantage Premier (PPO)	H0104-015	4	Yes	No	No
Blue Cross Medicare Advantage Choice (PPO)	H5959-009	4	Yes	No	No
Blue Cross Medicare Advantage Choice (PPO)	H5959-014	4	Yes	No	No
Blue Cross Medicare Advantage Choice (PPO)	H5959-014	4	Yes	No	No
Blue Cross Medicare Advantage Comfort (PPO)	H5959-015	4	Yes	No	No
Blue Cross Medicare Advantage Comfort (PPO)	H5959-016	4	Yes	No	No
Blue Cross Medicare Advantage Complete (PPO)	H5959-010	4	Yes	No	No
Blue Cross Medicare Advantage Complete (PPO)	H5959-010	4	Yes	No	No
Blue Cross Medicare Advantage Complete (PPO)	H5959-011	4	Yes	No	No
Blue Cross Medicare Advantage Core (PPO)	H5959-012	4	Yes	No	No
Blue Cross Medicare Advantage Core (PPO)	H5959-013	4	Yes	No	No
Blue Cross Medicare Advantage Core (PPO)	H5959-013	4	Yes	No	No
Blue Cross Medicare Advantage Secure (HMO)	H8547-001	4	Yes	No	No
Blue Medicare Advantage Classic PPO (PPO)	H5900-008	4	Yes	No	No
Blue Medicare Advantage Enhanced PPO (PPO)	H5900-004	4	Yes	No	No
Blue Medicare Advantage PPO (PPO)	H5900-001	4	Yes	No	No
Blue Medicare Choice (HMO)	H3449-026	4	Yes	No	No
Blue Medicare Enhanced (HMO-POS)	H3449-024	4	Yes	No	No
Blue Medicare Enhanced (HMO-POS)	H3449-024	4	Yes	No	No
Blue Medicare Enhanced (HMO-POS)	H3449-024	4	Yes	No	No
Blue Medicare Essential (HMO)	H3449-027	4	Yes	No	No
Blue Medicare Essential (HMO)	H3449-027	4	Yes	No	No
Blue Medicare Essential Plus (HMO-POS)	H3449-023	4	Yes	No	No
Blue Medicare Essential Plus (HMO-POS)	H3449-023	4	Yes	No	No
Blue Medicare Essential Plus (HMO-POS)	H3449-023	4	Yes	No	No
Blue Medicare Essential Plus (HMO-POS)	H3449-023	4	Yes	No	No
Blue Medicare PPO Enhanced (PPO)	H3404-003	4	Yes	No	No
Blue Medicare PPO Enhanced (PPO)	H3404-003	4	Yes	No	No
Blue Medicare Rx Enhanced (PDP)	S5540-004	4	Yes	No	No
Blue Medicare Rx Standard (PDP)	S5540-002	4	Yes	No	No
Blue MedicareRx Essentials (PDP)	S5726-020	4	Yes	No	No
Blue MedicareRx Plus (PDP)	S5726-014	4	Yes	No	No
Blue MedicareRx Value (PDP)	S5726-013	4	Yes	No	No
BlueCHiP for Medicare Access (HMO-POS)	H4152-022	4	Yes	No	No
BlueCHiP for Medicare Enhanced (HMO-POS)	H4152-013	4	Yes	No	No
BlueCHiP for Medicare Essential (HMO-POS)	H4152-023	4	Yes	No	No
BlueCHiP for Medicare Extra (HMO-POS)	H4152-018	4	Yes	No	No
BlueMedicare Complete Rx (PDP)	S5904-002	4	Yes	No	No
BlueMedicare Premier Rx (PDP)	S5904-001	4	Yes	No	No
BlueMedicare Select (PPO)	H5434-002	4	Yes	No	No
BlueMedicare Select (PPO)	H5434-045	4	Yes	No	No
BlueMedicare Value (PPO)	H5434-023	4	Yes	No	No
BlueMedicare Value (PPO)	H5434-024	4	Yes	No	No
BlueMedicare Value (PPO)	H5434-025	4	Yes	No	No
BlueMedicare Value (PPO)	H5434-026	4	Yes	No	No
BlueMedicare Value (PPO)	H5434-030	4	Yes	No	No
BlueMedicare Value (PPO)	H5434-031	4	Yes	No	No
BlueMedicare Value (PPO)	H5434-034	4	Yes	No	No
BlueMedicare Value (PPO)	H5434-035	4	Yes	No	No
BlueMedicare Value (PPO)	H5434-036	4	Yes	No	No
BlueRI for Duals (HMO D-SNP)	H4152-021	4	Yes	No	No
BlueRx Enhanced Plus (PDP)	S1030-001	4	Yes	No	No

Showing 100 of 269 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.

Amnesteem at other payers

Or see Amnesteem 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.