Varies by plan
Does Blue Cross Blue Shield (affiliate) require prior authorization for Fyavolv?
Prior authorization for Fyavolv differs across Blue Cross Blue Shield (affiliate)'s Medicare Part D plans and product strengths — 2 of 2 Fyavolv 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: 16 of 71 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: 36 of 62 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 | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| ethinyl estradiol 0.0025 MG / norethindrone acetate 0.5 MG Oral Tablet [Fyavolv]1736654 | 71 / 269 | 16 | 0 | 0 | Varies by plan |
| ethinyl estradiol 0.005 MG / norethindrone acetate 1 MG Oral Tablet [Fyavolv]1736656 | 62 / 269 | 36 | 0 | 0 | Varies by plan |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — ethinyl estradiol 0.0025 MG / norethindrone acetate 0.5 MG Oral Tablet [Fyavolv]
Fyavolv has 2 products in the corpus; this table is for ethinyl estradiol 0.0025 MG / norethindrone acetate 0.5 MG Oral Tablet [Fyavolv], 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 | 3 | Yes | No | No |
| Anthem Extra Help (HMO-POS) | H5422-013 | 3 | Yes | No | No |
| Anthem Full Dual Advantage (HMO D-SNP) | H5422-019 | 3 | Yes | No | No |
| Anthem Full Dual Advantage Aligned (HMO D-SNP) | H4471-011 | 3 | Yes | No | No |
| Anthem Kidney Care (HMO-POS C-SNP) | H5422-015 | 3 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H0544-056 | 3 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H0544-064 | 3 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H0544-065 | 3 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H0544-095 | 3 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H5422-011 | 3 | Yes | No | No |
| Blue Medicare Advantage Classic PPO (PPO) | H5900-008 | 3 | No | No | No |
| Blue Medicare Advantage Enhanced PPO (PPO) | H5900-004 | 3 | No | No | No |
| Blue Medicare Advantage PPO (PPO) | H5900-001 | 3 | No | No | No |
| CareFirst BlueCross BlueShield Advantage Complete (PPO) | H7379-002 | 3 | No | No | No |
| CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) | H8854-002 | 3 | No | No | No |
| CareFirst BlueCross BlueShield Advantage Essential (PPO) | H7379-001 | 3 | No | No | No |
| Freedom Blue PPO Classic (PPO) | H3916-001 | 4 | No | No | No |
| Freedom Blue PPO Classic (PPO) | H3916-002 | 4 | No | No | No |
| Freedom Blue PPO Deluxe (PPO) | H3916-005 | 4 | No | No | No |
| Freedom Blue PPO Select (PPO) | H3916-022 | 4 | No | No | No |
| Freedom Blue PPO Select (PPO) | H3916-024 | 4 | No | No | No |
| Freedom Blue PPO Standard (PPO) | H3916-015 | 4 | No | No | No |
| Medicare HMO Blue FlexRx (HMO-POS) | H2261-023 | 3 | No | No | No |
| Medicare HMO Blue FlexRx (HMO-POS) | H2261-023 | 3 | No | No | No |
| Medicare HMO Blue PlusRx (HMO) | H2261-005 | 3 | No | No | No |
| Medicare HMO Blue SaverRx (HMO-POS) | H2261-024 | 3 | No | No | No |
| Medicare HMO Blue ValueRx (HMO) | H2261-022 | 3 | No | No | No |
| Medicare HMO Blue ValueRx (HMO) | H2261-022 | 3 | No | No | No |
| Medicare Plus Blue + Meijer (PPO) | H9572-007 | 4 | No | No | No |
| Medicare Plus Blue + Meijer (PPO) | H9572-007 | 4 | No | No | No |
| Medicare Plus Blue + Meijer (PPO) | H9572-007 | 4 | No | No | No |
| Medicare Plus Blue + Meijer (PPO) | H9572-007 | 4 | No | No | No |
| Medicare Plus Blue + Meijer (PPO) | H9572-007 | 4 | No | No | No |
| Medicare Plus Blue Assure (PPO) | H9572-003 | 4 | No | No | No |
| Medicare Plus Blue Assure (PPO) | H9572-003 | 4 | No | No | No |
| Medicare Plus Blue Assure (PPO) | H9572-003 | 4 | No | No | No |
| Medicare Plus Blue Assure (PPO) | H9572-003 | 4 | No | No | No |
| Medicare Plus Blue Assure (PPO) | H9572-003 | 4 | No | No | No |
| Medicare Plus Blue Essential (PPO) | H9572-004 | 4 | No | No | No |
| Medicare Plus Blue Essential (PPO) | H9572-004 | 4 | No | No | No |
| Medicare Plus Blue Essential (PPO) | H9572-004 | 4 | No | No | No |
| Medicare Plus Blue Essential (PPO) | H9572-004 | 4 | No | No | No |
| Medicare Plus Blue Giveback (PPO) | H9572-008 | 4 | No | No | No |
| Medicare Plus Blue Secure (PPO) | H9572-009 | 4 | No | No | No |
| Medicare Plus Blue Signature (PPO) | H9572-001 | 4 | No | No | No |
| Medicare Plus Blue Signature (PPO) | H9572-001 | 4 | No | No | No |
| Medicare Plus Blue Signature (PPO) | H9572-001 | 4 | No | No | No |
| Medicare Plus Blue Signature (PPO) | H9572-001 | 4 | No | No | No |
| Medicare Plus Blue Signature (PPO) | H9572-001 | 4 | No | No | No |
| Medicare Plus Blue Value (PPO) | H9572-010 | 4 | No | No | No |
| Medicare Plus Blue Vitality (PPO) | H9572-002 | 4 | No | No | No |
| Medicare Plus Blue Vitality (PPO) | H9572-002 | 4 | No | No | No |
| Medicare Plus Blue Vitality (PPO) | H9572-002 | 4 | No | No | No |
| Medicare Plus Blue Vitality (PPO) | H9572-002 | 4 | No | No | No |
| Medicare Plus Blue Vitality (PPO) | H9572-002 | 4 | No | No | No |
| Medicare PPO Blue EssentialRx (PPO) | H2230-019 | 3 | No | No | No |
| Medicare PPO Blue PlusRx (PPO) | H2230-002 | 3 | No | No | No |
| Medicare PPO Blue ValueRx (PPO) | H2230-018 | 3 | No | No | No |
| Medicare PPO Blue ValueRx (PPO) | H2230-018 | 3 | No | No | No |
| Prescription Blue Premium (PDP) | S5584-002 | 4 | No | No | No |
| Prescription Blue Select (PDP) | S5584-001 | 4 | No | No | No |
| Security Blue HMO-POS Deluxe (HMO-POS) | H3957-046 | 4 | No | No | No |
| Security Blue HMO-POS Deluxe (HMO-POS) | H3957-046 | 4 | No | No | No |
| Security Blue HMO-POS Standard (HMO-POS) | H3957-045 | 4 | No | No | No |
| Security Blue HMO-POS Standard (HMO-POS) | H3957-045 | 4 | No | No | No |
| True Blue Rx 32PSP (HMO) | H1350-032 | 3 | Yes | No | No |
| True Blue Rx 33 (HMO) | H1350-033 | 3 | Yes | No | No |
| True Blue Rx 34 (HMO) | H1350-034 | 3 | Yes | No | No |
| True Blue Rx 35PSP (HMO) | H1350-035 | 3 | Yes | No | No |
| True Blue Rx 36 (HMO) | H1350-036 | 3 | Yes | No | No |
| True Blue Rx 37 (HMO) | H1350-037 | 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.
Fyavolv 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.