Does Blue Cross Blue Shield (affiliate) require prior authorization for Gleostine?
Blue Cross Blue Shield (affiliate) does not require prior authorization for Gleostine on the Medicare Part D plans that cover it.
No covering plan from this payer files a prior-authorization requirement for this drug.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| lomustine 10 MG Oral Capsule [Gleostine]1545776 | 45 / 269 | 0 | 0 | 0 | No prior authorization |
| lomustine 100 MG Oral Capsule [Gleostine]1545778 | 45 / 269 | 0 | 0 | 0 | No prior authorization |
| lomustine 40 MG Oral Capsule [Gleostine]1545780 | 45 / 269 | 0 | 0 | 0 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — lomustine 10 MG Oral Capsule [Gleostine]
Gleostine has 3 products in the corpus; this table is for lomustine 10 MG Oral Capsule [Gleostine], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Blue Medicare Advantage Classic PPO (PPO) | H5900-008 | 4 | No | No | No |
| Blue Medicare Advantage Enhanced PPO (PPO) | H5900-004 | 4 | No | No | No |
| Blue Medicare Advantage PPO (PPO) | H5900-001 | 4 | No | No | No |
| CareFirst BlueCross BlueShield Advantage Complete (PPO) | H7379-002 | 4 | No | No | No |
| CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) | H8854-002 | 4 | No | No | No |
| CareFirst BlueCross BlueShield Advantage Essential (PPO) | H7379-001 | 4 | No | No | No |
| Medicare HMO Blue FlexRx (HMO-POS) | H2261-023 | 4 | No | No | No |
| Medicare HMO Blue FlexRx (HMO-POS) | H2261-023 | 4 | No | No | No |
| Medicare HMO Blue PlusRx (HMO) | H2261-005 | 4 | No | No | No |
| Medicare HMO Blue SaverRx (HMO-POS) | H2261-024 | 4 | No | No | No |
| Medicare HMO Blue ValueRx (HMO) | H2261-022 | 4 | No | No | No |
| Medicare HMO Blue ValueRx (HMO) | H2261-022 | 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 + 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 | 4 | No | No | No |
| Medicare PPO Blue PlusRx (PPO) | H2230-002 | 4 | No | No | No |
| Medicare PPO Blue ValueRx (PPO) | H2230-018 | 4 | No | No | No |
| Medicare PPO Blue ValueRx (PPO) | H2230-018 | 4 | No | No | No |
| Prescription Blue Premium (PDP) | S5584-002 | 4 | No | No | No |
| Prescription Blue Select (PDP) | S5584-001 | 4 | No | No | No |
- 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.
Gleostine 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.