Prior authorization required
Does Blue Cross Blue Shield (affiliate) require prior authorization for Astagraf?
Blue Cross Blue Shield (affiliate) requires prior authorization for Astagraf 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 |
|---|---|---|---|---|---|
| 24 HR tacrolimus 0.5 MG Extended Release Oral Capsule [Astagraf]1431977 | 70 / 269 | 70 | 0 | 0 | Prior authorization required |
| 24 HR tacrolimus 1 MG Extended Release Oral Capsule [Astagraf]1431982 | 70 / 269 | 70 | 0 | 0 | Prior authorization required |
| 24 HR tacrolimus 5 MG Extended Release Oral Capsule [Astagraf]1431987 | 70 / 269 | 70 | 0 | 0 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — 24 HR tacrolimus 0.5 MG Extended Release Oral Capsule [Astagraf]
Astagraf has 3 products in the corpus; this table is for 24 HR tacrolimus 0.5 MG Extended Release Oral Capsule [Astagraf], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Anthem I CareMore Chronic Care (HMO-POS C-SNP) | H0544-004 | 4 | Yes | No | No |
| Anthem I CareMore Chronic Care (HMO-POS C-SNP) | H0544-010 | 4 | Yes | No | No |
| Anthem I CareMore Chronic Care 2 (HMO-POS C-SNP) | H4161-014 | 4 | Yes | No | No |
| Anthem I CareMore Chronic Care 2 (HMO-POS C-SNP) | H4161-015 | 4 | Yes | No | No |
| Anthem I CareMore Home Care (HMO I-SNP) | H0544-005 | 4 | Yes | No | No |
| Anthem I CareMore Kidney Care (HMO-POS C-SNP) | H0544-015 | 4 | Yes | No | No |
| Anthem I CareMore Kidney Care (HMO-POS C-SNP) | H0544-020 | 4 | Yes | No | No |
| Anthem I CareMore Lung Care (HMO-POS C-SNP) | H0544-014 | 4 | Yes | No | No |
| Anthem I CareMore Lung Care (HMO-POS C-SNP) | H0544-019 | 4 | Yes | No | No |
| Anthem I CareMore Lung Care 2 (HMO-POS C-SNP) | H4161-016 | 4 | Yes | No | No |
| Anthem I CareMore Lung Care 2 (HMO-POS C-SNP) | H4161-017 | 4 | Yes | No | No |
| Anthem I CareMore Medicare Advantage (HMO-POS) | H4161-011 | 4 | Yes | No | No |
| Anthem I CareMore Medicare Advantage (HMO-POS) | H4161-013 | 4 | Yes | No | No |
| Anthem I CareMore Medicare Advantage 2 (HMO-POS) | H0544-002 | 4 | Yes | No | No |
| Anthem I CareMore Premium Savings (HMO-POS) | H4161-012 | 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 |
| CareFirst BlueCross BlueShield Advantage Complete (PPO) | H7379-002 | 4 | Yes | No | No |
| CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) | H8854-002 | 4 | Yes | No | No |
| CareFirst BlueCross BlueShield Advantage Essential (PPO) | H7379-001 | 4 | Yes | No | No |
| Freedom Blue PPO Classic (PPO) | H3916-001 | 3 | Yes | No | No |
| Freedom Blue PPO Classic (PPO) | H3916-002 | 3 | Yes | No | No |
| Freedom Blue PPO Deluxe (PPO) | H3916-005 | 3 | Yes | No | No |
| Freedom Blue PPO Select (PPO) | H3916-022 | 3 | Yes | No | No |
| Freedom Blue PPO Select (PPO) | H3916-024 | 3 | Yes | No | No |
| Freedom Blue PPO Standard (PPO) | H3916-015 | 3 | Yes | No | No |
| Medicare HMO Blue FlexRx (HMO-POS) | H2261-023 | 4 | Yes | No | No |
| Medicare HMO Blue FlexRx (HMO-POS) | H2261-023 | 4 | Yes | No | No |
| Medicare HMO Blue PlusRx (HMO) | H2261-005 | 4 | Yes | No | No |
| Medicare HMO Blue SaverRx (HMO-POS) | H2261-024 | 4 | Yes | No | No |
| Medicare HMO Blue ValueRx (HMO) | H2261-022 | 4 | Yes | No | No |
| Medicare HMO Blue ValueRx (HMO) | H2261-022 | 4 | Yes | No | No |
| Medicare Plus Blue + Meijer (PPO) | H9572-007 | 4 | Yes | No | No |
| Medicare Plus Blue + Meijer (PPO) | H9572-007 | 4 | Yes | No | No |
| Medicare Plus Blue + Meijer (PPO) | H9572-007 | 4 | Yes | No | No |
| Medicare Plus Blue + Meijer (PPO) | H9572-007 | 4 | Yes | No | No |
| Medicare Plus Blue + Meijer (PPO) | H9572-007 | 4 | Yes | No | No |
| Medicare Plus Blue Assure (PPO) | H9572-003 | 4 | Yes | No | No |
| Medicare Plus Blue Assure (PPO) | H9572-003 | 4 | Yes | No | No |
| Medicare Plus Blue Assure (PPO) | H9572-003 | 4 | Yes | No | No |
| Medicare Plus Blue Assure (PPO) | H9572-003 | 4 | Yes | No | No |
| Medicare Plus Blue Assure (PPO) | H9572-003 | 4 | Yes | No | No |
| Medicare Plus Blue Essential (PPO) | H9572-004 | 4 | Yes | No | No |
| Medicare Plus Blue Essential (PPO) | H9572-004 | 4 | Yes | No | No |
| Medicare Plus Blue Essential (PPO) | H9572-004 | 4 | Yes | No | No |
| Medicare Plus Blue Essential (PPO) | H9572-004 | 4 | Yes | No | No |
| Medicare Plus Blue Giveback (PPO) | H9572-008 | 4 | Yes | No | No |
| Medicare Plus Blue Secure (PPO) | H9572-009 | 4 | Yes | No | No |
| Medicare Plus Blue Signature (PPO) | H9572-001 | 4 | Yes | No | No |
| Medicare Plus Blue Signature (PPO) | H9572-001 | 4 | Yes | No | No |
| Medicare Plus Blue Signature (PPO) | H9572-001 | 4 | Yes | No | No |
| Medicare Plus Blue Signature (PPO) | H9572-001 | 4 | Yes | No | No |
| Medicare Plus Blue Signature (PPO) | H9572-001 | 4 | Yes | No | No |
| Medicare Plus Blue Value (PPO) | H9572-010 | 4 | Yes | No | No |
| Medicare Plus Blue Vitality (PPO) | H9572-002 | 4 | Yes | No | No |
| Medicare Plus Blue Vitality (PPO) | H9572-002 | 4 | Yes | No | No |
| Medicare Plus Blue Vitality (PPO) | H9572-002 | 4 | Yes | No | No |
| Medicare Plus Blue Vitality (PPO) | H9572-002 | 4 | Yes | No | No |
| Medicare Plus Blue Vitality (PPO) | H9572-002 | 4 | Yes | No | No |
| Medicare PPO Blue EssentialRx (PPO) | H2230-019 | 4 | Yes | No | No |
| Medicare PPO Blue PlusRx (PPO) | H2230-002 | 4 | Yes | No | No |
| Medicare PPO Blue ValueRx (PPO) | H2230-018 | 4 | Yes | No | No |
| Medicare PPO Blue ValueRx (PPO) | H2230-018 | 4 | Yes | No | No |
| Prescription Blue Premium (PDP) | S5584-002 | 4 | Yes | No | No |
| Prescription Blue Select (PDP) | S5584-001 | 4 | Yes | No | No |
| Security Blue HMO-POS Deluxe (HMO-POS) | H3957-046 | 3 | Yes | No | No |
| Security Blue HMO-POS Deluxe (HMO-POS) | H3957-046 | 3 | Yes | No | No |
| Security Blue HMO-POS Standard (HMO-POS) | H3957-045 | 3 | Yes | No | No |
| Security Blue HMO-POS Standard (HMO-POS) | H3957-045 | 3 | Yes | No | No |
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.
Astagraf 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.