Varies by plan
Does Blue Cross Blue Shield (affiliate) require prior authorization for Lyllana?
Prior authorization for Lyllana differs across Blue Cross Blue Shield (affiliate)'s Medicare Part D plans and product strengths — 5 of 5 Lyllana 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: 6 of 106 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 |
|---|---|---|---|---|---|
| 84 HR estradiol 0.00104 MG/HR Transdermal System [Lyllana]2399892 | 106 / 269 | 6 | 0 | 6 | Varies by plan |
| 84 HR estradiol 0.00156 MG/HR Transdermal System [Lyllana]2399895 | 106 / 269 | 6 | 0 | 6 | Varies by plan |
| 84 HR estradiol 0.00208 MG/HR Transdermal System [Lyllana]2399898 | 106 / 269 | 6 | 0 | 6 | Varies by plan |
| 84 HR estradiol 0.00313 MG/HR Transdermal System [Lyllana]2399901 | 106 / 269 | 6 | 0 | 6 | Varies by plan |
| 84 HR estradiol 0.00417 MG/HR Transdermal System [Lyllana]2399904 | 106 / 269 | 6 | 0 | 6 | Varies by plan |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — 84 HR estradiol 0.00104 MG/HR Transdermal System [Lyllana]
Lyllana has 5 products in the corpus; this table is for 84 HR estradiol 0.00104 MG/HR Transdermal System [Lyllana], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Blue Advantage Choice (PPO) | H0104-016 | 3 | No | No | No |
| Blue Advantage Complete (PPO) | H0104-012 | 3 | No | No | No |
| Blue Advantage Complete (PPO) | H0104-014 | 3 | No | No | No |
| Blue Advantage Premier (PPO) | H0104-015 | 3 | No | No | No |
| Blue Cross Medicare Advantage Choice (PPO) | H5959-009 | 3 | No | No | No |
| Blue Cross Medicare Advantage Choice (PPO) | H5959-014 | 3 | No | No | No |
| Blue Cross Medicare Advantage Choice (PPO) | H5959-014 | 3 | No | No | No |
| Blue Cross Medicare Advantage Comfort (PPO) | H5959-015 | 3 | No | No | No |
| Blue Cross Medicare Advantage Comfort (PPO) | H5959-016 | 3 | No | No | No |
| Blue Cross Medicare Advantage Complete (PPO) | H5959-010 | 3 | No | No | No |
| Blue Cross Medicare Advantage Complete (PPO) | H5959-010 | 3 | No | No | No |
| Blue Cross Medicare Advantage Complete (PPO) | H5959-011 | 3 | No | No | No |
| Blue Cross Medicare Advantage Core (PPO) | H5959-012 | 3 | No | No | No |
| Blue Cross Medicare Advantage Core (PPO) | H5959-013 | 3 | No | No | No |
| Blue Cross Medicare Advantage Core (PPO) | H5959-013 | 3 | No | No | No |
| Blue Cross Medicare Advantage Secure (HMO) | H8547-001 | 4 | No | 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 |
| Blue Medicare Choice (HMO) | H3449-026 | 3 | No | No | No |
| Blue Medicare Enhanced (HMO-POS) | H3449-024 | 3 | No | No | No |
| Blue Medicare Enhanced (HMO-POS) | H3449-024 | 3 | No | No | No |
| Blue Medicare Enhanced (HMO-POS) | H3449-024 | 3 | No | No | No |
| Blue Medicare Essential (HMO) | H3449-027 | 3 | No | No | No |
| Blue Medicare Essential (HMO) | H3449-027 | 3 | No | No | No |
| Blue Medicare Essential Plus (HMO-POS) | H3449-023 | 3 | No | No | No |
| Blue Medicare Essential Plus (HMO-POS) | H3449-023 | 3 | No | No | No |
| Blue Medicare Essential Plus (HMO-POS) | H3449-023 | 3 | No | No | No |
| Blue Medicare Essential Plus (HMO-POS) | H3449-023 | 3 | No | No | No |
| Blue Medicare PPO Enhanced (PPO) | H3404-003 | 3 | No | No | No |
| Blue Medicare PPO Enhanced (PPO) | H3404-003 | 3 | No | No | No |
| Blue Medicare Rx Enhanced (PDP) | S5540-004 | 3 | No | No | No |
| Blue Medicare Rx Standard (PDP) | S5540-002 | 4 | No | No | No |
| Blue MedicareRx Essentials (PDP) | S5726-020 | 4 | No | No | No |
| Blue MedicareRx Plus (PDP) | S5726-014 | 3 | No | No | No |
| Blue MedicareRx Value (PDP) | S5726-013 | 4 | No | No | No |
| BlueCHiP for Medicare Access (HMO-POS) | H4152-022 | 3 | No | No | No |
| BlueCHiP for Medicare Enhanced (HMO-POS) | H4152-013 | 3 | No | No | No |
| BlueCHiP for Medicare Essential (HMO-POS) | H4152-023 | 3 | No | No | No |
| BlueCHiP for Medicare Extra (HMO-POS) | H4152-018 | 3 | No | No | No |
| BlueMedicare Complete Rx (PDP) | S5904-002 | 4 | No | No | No |
| BlueMedicare Premier Rx (PDP) | S5904-001 | 4 | No | No | No |
| BlueMedicare Select (PPO) | H5434-002 | 4 | No | No | No |
| BlueMedicare Select (PPO) | H5434-045 | 4 | No | No | No |
| BlueMedicare Value (PPO) | H5434-023 | 4 | No | No | No |
| BlueMedicare Value (PPO) | H5434-024 | 4 | No | No | No |
| BlueMedicare Value (PPO) | H5434-025 | 4 | No | No | No |
| BlueMedicare Value (PPO) | H5434-026 | 4 | No | No | No |
| BlueMedicare Value (PPO) | H5434-030 | 4 | No | No | No |
| BlueMedicare Value (PPO) | H5434-031 | 4 | No | No | No |
| BlueMedicare Value (PPO) | H5434-034 | 4 | No | No | No |
| BlueMedicare Value (PPO) | H5434-035 | 4 | No | No | No |
| BlueMedicare Value (PPO) | H5434-036 | 4 | No | No | No |
| BlueRI for Duals (HMO D-SNP) | H4152-021 | 3 | No | No | No |
| BlueRx Enhanced Plus (PDP) | S1030-001 | 4 | No | No | No |
| BlueRx Essential (PDP) | S1030-006 | 4 | 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 |
| Experience Health Medicare Advantage (HMO) | H3777-002 | 3 | No | No | No |
| Freedom Blue PPO Classic (PPO) | H3916-001 | 2 | No | No | No |
| Freedom Blue PPO Classic (PPO) | H3916-002 | 2 | No | No | No |
| Freedom Blue PPO Deluxe (PPO) | H3916-005 | 2 | No | No | No |
| Freedom Blue PPO Select (PPO) | H3916-022 | 2 | No | No | No |
| Freedom Blue PPO Select (PPO) | H3916-024 | 2 | No | No | No |
| Freedom Blue PPO Standard (PPO) | H3916-015 | 2 | No | No | No |
| Healthy Blue + Medicare (HMO-POS D-SNP) | H9147-001 | 3 | 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 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 |
| MedicareBlue Rx Standard (PDP) | S5743-001 | 4 | No | No | No |
| Platinum Blue Choice Plan with Rx (Cost) | H2461-009 | 3 | No | No | No |
| Platinum Blue Complete Plan with Rx (Cost) | H2461-010 | 3 | No | No | No |
| Platinum Blue Core Plan with Rx (Cost) | H2461-008 | 3 | No | No | No |
| Regence BlueAdvantage HMO (HMO) | H1997-013 | 3 | No | No | No |
| Regence BlueAdvantage HMO (HMO) | H6237-009 | 3 | No | No | No |
| Regence MedAdvantage + Rx Classic (PPO) | H3817-008 | 3 | No | No | No |
| Regence MedAdvantage + Rx Classic (PPO) | H3817-008 | 3 | No | No | No |
| Regence MedAdvantage + Rx Classic (PPO) | H3817-008 | 3 | No | No | No |
| Regence MedAdvantage + Rx Classic (PPO) | H4605-002 | 3 | No | No | No |
| Regence MedAdvantage + Rx Enhanced (PPO) | H3817-009 | 3 | No | No | No |
| Regence MedAdvantage + Rx Enhanced (PPO) | H3817-009 | 3 | No | No | No |
| Regence MedAdvantage + Rx Enhanced (PPO) | H4605-004 | 3 | No | No | No |
| Regence MedAdvantage + Rx Enhanced (PPO) | H5009-002 | 3 | No | No | No |
| Regence MedAdvantage + Rx Primary (PPO) | H3817-011 | 3 | No | No | No |
| Regence MedAdvantage + Rx Primary (PPO) | H3817-011 | 3 | No | No | No |
| Regence MedAdvantage + Rx Primary (PPO) | H3817-011 | 3 | No | No | No |
| Regence MedAdvantage + Rx Primary (PPO) | H5009-011 | 3 | No | No | No |
| Regence MedAdvantage + Rx Primary (PPO) | H5009-011 | 3 | No | No | No |
| Security Blue HMO-POS Deluxe (HMO-POS) | H3957-046 | 2 | No | No | No |
| Security Blue HMO-POS Deluxe (HMO-POS) | H3957-046 | 2 | No | No | No |
| Security Blue HMO-POS Standard (HMO-POS) | H3957-045 | 2 | No | No | No |
| Security Blue HMO-POS Standard (HMO-POS) | H3957-045 | 2 | No | No | No |
Showing 100 of 106 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.
Lyllana 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.