Varies by plan

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

Prior authorization for Cobenfy differs across Blue Cross Blue Shield (affiliate)'s Medicare Part D plans and product strengths — 3 of 3 Cobenfy 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: 238 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.

By product strength

RxNorm product	Plans covering	Require prior auth	Qty limit	Status
trospium chloride 20 MG / xanomeline 50 MG Oral Capsule [Cobenfy]2694850	269 / 269	238	269	Varies by plan
trospium chloride 30 MG / xanomeline 125 MG Oral Capsule [Cobenfy]2694855	269 / 269	238	269	Varies by plan
trospium chloride 20 MG / xanomeline 100 MG Oral Capsule [Cobenfy]2694991	269 / 269	238	269	Varies by plan

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

Plan-by-plan detail — trospium chloride 20 MG / xanomeline 50 MG Oral Capsule [Cobenfy]

Cobenfy has 3 products in the corpus; this table is for trospium chloride 20 MG / xanomeline 50 MG Oral Capsule [Cobenfy], 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	Yes	No	Yes
Anthem Extra Help (HMO-POS)	H5422-013	4	Yes	No	Yes
Anthem Full Dual Advantage (HMO D-SNP)	H5422-019	4	Yes	No	Yes
Anthem Full Dual Advantage Aligned (HMO D-SNP)	H4471-010	4	Yes	No	Yes
Anthem Full Dual Advantage Aligned (HMO D-SNP)	H4471-010	4	Yes	No	Yes
Anthem Full Dual Advantage Aligned (HMO D-SNP)	H4471-011	4	Yes	No	Yes
Anthem I CareMore Chronic Care (HMO-POS C-SNP)	H0544-004	4	Yes	No	Yes
Anthem I CareMore Chronic Care (HMO-POS C-SNP)	H0544-010	4	Yes	No	Yes
Anthem I CareMore Chronic Care 2 (HMO-POS C-SNP)	H4161-014	4	Yes	No	Yes
Anthem I CareMore Chronic Care 2 (HMO-POS C-SNP)	H4161-015	4	Yes	No	Yes
Anthem I CareMore Home Care (HMO I-SNP)	H0544-005	4	Yes	No	Yes
Anthem I CareMore Kidney Care (HMO-POS C-SNP)	H0544-015	4	Yes	No	Yes
Anthem I CareMore Kidney Care (HMO-POS C-SNP)	H0544-020	4	Yes	No	Yes
Anthem I CareMore Lung Care (HMO-POS C-SNP)	H0544-014	4	Yes	No	Yes
Anthem I CareMore Lung Care (HMO-POS C-SNP)	H0544-019	4	Yes	No	Yes
Anthem I CareMore Lung Care 2 (HMO-POS C-SNP)	H4161-016	4	Yes	No	Yes
Anthem I CareMore Lung Care 2 (HMO-POS C-SNP)	H4161-017	4	Yes	No	Yes
Anthem I CareMore Medicare Advantage (HMO-POS)	H4161-011	4	Yes	No	Yes
Anthem I CareMore Medicare Advantage (HMO-POS)	H4161-013	4	Yes	No	Yes
Anthem I CareMore Medicare Advantage 2 (HMO-POS)	H0544-002	4	Yes	No	Yes
Anthem I CareMore Premium Savings (HMO-POS)	H4161-012	4	Yes	No	Yes
Anthem Kidney Care (HMO-POS C-SNP)	H5422-015	4	Yes	No	Yes
Anthem Medicare Advantage (HMO-POS)	H0544-056	4	Yes	No	Yes
Anthem Medicare Advantage (HMO-POS)	H0544-061	4	Yes	No	Yes
Anthem Medicare Advantage (HMO-POS)	H0544-062	4	Yes	No	Yes
Anthem Medicare Advantage (HMO-POS)	H0544-063	4	Yes	No	Yes
Anthem Medicare Advantage (HMO-POS)	H0544-064	4	Yes	No	Yes
Anthem Medicare Advantage (HMO-POS)	H0544-065	4	Yes	No	Yes
Anthem Medicare Advantage (HMO-POS)	H0544-095	4	Yes	No	Yes
Anthem Medicare Advantage (HMO-POS)	H0544-096	4	Yes	No	Yes
Anthem Medicare Advantage (HMO-POS)	H0544-108	4	Yes	No	Yes
Anthem Medicare Advantage (HMO-POS)	H5422-011	4	Yes	No	Yes
Anthem Prime (HMO-POS)	H4161-002	4	Yes	No	Yes
Anthem Prime (HMO-POS)	H4161-003	4	Yes	No	Yes
Anthem Prime (HMO-POS)	H4161-004	4	Yes	No	Yes
Anthem Prime (HMO-POS)	H4161-005	4	Yes	No	Yes
Anthem Prime (HMO-POS)	H4161-006	4	Yes	No	Yes
Anthem Prime (HMO-POS)	H4161-007	4	Yes	No	Yes
Anthem Prime (HMO-POS)	H4161-009	4	Yes	No	Yes
Anthem Prime (HMO-POS)	H4161-010	4	Yes	No	Yes
Anthem Select (HMO-POS)	H0544-058	4	Yes	No	Yes
Anthem Select (HMO-POS)	H0544-066	4	Yes	No	Yes
Anthem Select (HMO-POS)	H0544-069	4	Yes	No	Yes
Anthem Select (HMO-POS)	H0544-091	4	Yes	No	Yes
Anthem Select (HMO-POS)	H0544-098	4	Yes	No	Yes
Blue Advantage Choice (PPO)	H0104-016	5	Yes	No	Yes
Blue Advantage Complete (PPO)	H0104-012	5	Yes	No	Yes
Blue Advantage Complete (PPO)	H0104-014	5	Yes	No	Yes
Blue Advantage Premier (PPO)	H0104-015	5	Yes	No	Yes
Blue Cross Medicare Advantage Choice (PPO)	H5959-009	5	Yes	No	Yes
Blue Cross Medicare Advantage Choice (PPO)	H5959-014	5	Yes	No	Yes
Blue Cross Medicare Advantage Choice (PPO)	H5959-014	5	Yes	No	Yes
Blue Cross Medicare Advantage Comfort (PPO)	H5959-015	5	Yes	No	Yes
Blue Cross Medicare Advantage Comfort (PPO)	H5959-016	5	Yes	No	Yes
Blue Cross Medicare Advantage Complete (PPO)	H5959-010	5	Yes	No	Yes
Blue Cross Medicare Advantage Complete (PPO)	H5959-010	5	Yes	No	Yes
Blue Cross Medicare Advantage Complete (PPO)	H5959-011	5	Yes	No	Yes
Blue Cross Medicare Advantage Core (PPO)	H5959-012	5	Yes	No	Yes
Blue Cross Medicare Advantage Core (PPO)	H5959-013	5	Yes	No	Yes
Blue Cross Medicare Advantage Core (PPO)	H5959-013	5	Yes	No	Yes
Blue Cross Medicare Advantage Secure (HMO)	H8547-001	5	Yes	No	Yes
Blue Medicare Advantage Classic PPO (PPO)	H5900-008	5	No	No	Yes
Blue Medicare Advantage Enhanced PPO (PPO)	H5900-004	5	No	No	Yes
Blue Medicare Advantage PPO (PPO)	H5900-001	5	No	No	Yes
Blue Medicare Choice (HMO)	H3449-026	5	Yes	No	Yes
Blue Medicare Enhanced (HMO-POS)	H3449-024	5	Yes	No	Yes
Blue Medicare Enhanced (HMO-POS)	H3449-024	5	Yes	No	Yes
Blue Medicare Enhanced (HMO-POS)	H3449-024	5	Yes	No	Yes
Blue Medicare Essential (HMO)	H3449-027	5	Yes	No	Yes
Blue Medicare Essential (HMO)	H3449-027	5	Yes	No	Yes
Blue Medicare Essential Plus (HMO-POS)	H3449-023	5	Yes	No	Yes
Blue Medicare Essential Plus (HMO-POS)	H3449-023	5	Yes	No	Yes
Blue Medicare Essential Plus (HMO-POS)	H3449-023	5	Yes	No	Yes
Blue Medicare Essential Plus (HMO-POS)	H3449-023	5	Yes	No	Yes
Blue Medicare PPO Enhanced (PPO)	H3404-003	5	Yes	No	Yes
Blue Medicare PPO Enhanced (PPO)	H3404-003	5	Yes	No	Yes
Blue Medicare Rx Enhanced (PDP)	S5540-004	5	Yes	No	Yes
Blue Medicare Rx Standard (PDP)	S5540-002	5	Yes	No	Yes
Blue MedicareRx Essentials (PDP)	S5726-020	5	Yes	No	Yes
Blue MedicareRx Plus (PDP)	S5726-014	5	Yes	No	Yes
Blue MedicareRx Value (PDP)	S5726-013	5	Yes	No	Yes
BlueCHiP for Medicare Access (HMO-POS)	H4152-022	5	Yes	No	Yes
BlueCHiP for Medicare Enhanced (HMO-POS)	H4152-013	5	Yes	No	Yes
BlueCHiP for Medicare Essential (HMO-POS)	H4152-023	5	Yes	No	Yes
BlueCHiP for Medicare Extra (HMO-POS)	H4152-018	5	Yes	No	Yes
BlueMedicare Complete Rx (PDP)	S5904-002	5	Yes	No	Yes
BlueMedicare Premier Rx (PDP)	S5904-001	5	Yes	No	Yes
BlueMedicare Select (PPO)	H5434-002	5	Yes	No	Yes
BlueMedicare Select (PPO)	H5434-045	5	Yes	No	Yes
BlueMedicare Value (PPO)	H5434-023	5	Yes	No	Yes
BlueMedicare Value (PPO)	H5434-024	5	Yes	No	Yes
BlueMedicare Value (PPO)	H5434-025	5	Yes	No	Yes
BlueMedicare Value (PPO)	H5434-026	5	Yes	No	Yes
BlueMedicare Value (PPO)	H5434-030	5	Yes	No	Yes
BlueMedicare Value (PPO)	H5434-031	5	Yes	No	Yes
BlueMedicare Value (PPO)	H5434-034	5	Yes	No	Yes
BlueMedicare Value (PPO)	H5434-035	5	Yes	No	Yes
BlueMedicare Value (PPO)	H5434-036	5	Yes	No	Yes
BlueRI for Duals (HMO D-SNP)	H4152-021	5	Yes	No	Yes
BlueRx Enhanced Plus (PDP)	S1030-001	5	Yes	No	Yes

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.

Cobenfy at other payers

Or see Cobenfy 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.