Prior authorization required

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

Blue Cross Blue Shield (affiliate) requires prior authorization for Savella 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	Qty limit	Status
milnacipran hydrochloride 100 MG Oral Tablet [Savella]833139	55 / 269	55	45	Prior authorization required
milnacipran hydrochloride 12.5 MG Oral Tablet [Savella]833143	55 / 269	55	45	Prior authorization required
milnacipran hydrochloride 50 MG Oral Tablet [Savella]833146	55 / 269	55	45	Prior authorization required
milnacipran hydrochloride 25 MG Oral Tablet [Savella]833149	55 / 269	55	45	Prior authorization required

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

Plan-by-plan detail — milnacipran hydrochloride 100 MG Oral Tablet [Savella]

Savella has 4 products in the corpus; this table is for milnacipran hydrochloride 100 MG Oral Tablet [Savella], 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
Freedom Blue PPO Classic (PPO)	H3916-001	4	Yes	No	No
Freedom Blue PPO Classic (PPO)	H3916-002	4	Yes	No	No
Freedom Blue PPO Deluxe (PPO)	H3916-005	4	Yes	No	No
Freedom Blue PPO Select (PPO)	H3916-022	4	Yes	No	No
Freedom Blue PPO Select (PPO)	H3916-024	4	Yes	No	No
Freedom Blue PPO Standard (PPO)	H3916-015	4	Yes	No	No
Security Blue HMO-POS Deluxe (HMO-POS)	H3957-046	4	Yes	No	No
Security Blue HMO-POS Deluxe (HMO-POS)	H3957-046	4	Yes	No	No
Security Blue HMO-POS Standard (HMO-POS)	H3957-045	4	Yes	No	No
Security Blue HMO-POS Standard (HMO-POS)	H3957-045	4	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.

Savella at other payers

Or see Savella 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.