Prior authorization required
Does Blue Cross Blue Shield (affiliate) require prior authorization for Uptravi?
Blue Cross Blue Shield (affiliate) requires prior authorization for Uptravi 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 | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| selexipag 1 MG Oral Tablet [Uptravi]1729013 | 115 / 269 | 115 | 0 | 115 | Prior authorization required |
| selexipag 1.2 MG Oral Tablet [Uptravi]1729029 | 115 / 269 | 115 | 0 | 115 | Prior authorization required |
| selexipag 1.4 MG Oral Tablet [Uptravi]1729033 | 115 / 269 | 115 | 0 | 115 | Prior authorization required |
| selexipag 1.6 MG Oral Tablet [Uptravi]1729047 | 115 / 269 | 115 | 0 | 115 | Prior authorization required |
| selexipag 0.2 MG Oral Tablet [Uptravi]1729053 | 115 / 269 | 115 | 0 | 115 | Prior authorization required |
| selexipag 0.4 MG Oral Tablet [Uptravi]1729057 | 115 / 269 | 115 | 0 | 115 | Prior authorization required |
| selexipag 0.6 MG Oral Tablet [Uptravi]1729061 | 115 / 269 | 115 | 0 | 115 | Prior authorization required |
| selexipag 0.8 MG Oral Tablet [Uptravi]1729065 | 115 / 269 | 115 | 0 | 115 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — selexipag 1 MG Oral Tablet [Uptravi]
Uptravi has 8 products in the corpus; this table is for selexipag 1 MG Oral Tablet [Uptravi], 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 | 5 | Yes | No | Yes |
| Blue Medicare Advantage Enhanced PPO (PPO) | H5900-004 | 5 | Yes | No | Yes |
| Blue Medicare Advantage PPO (PPO) | H5900-001 | 5 | Yes | No | Yes |
| CareFirst BlueCross BlueShield Advantage Complete (PPO) | H7379-002 | 5 | Yes | No | Yes |
| CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) | H8854-002 | 5 | Yes | No | Yes |
| CareFirst BlueCross BlueShield Advantage Essential (PPO) | H7379-001 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3384-070 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3384-070 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3384-070 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Merit (HMO) | H3384-071 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3384-069 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3384-069 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3384-069 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-042 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-042 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-042 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-042 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-042 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-042 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-047 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-047 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-047 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-047 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-047 | 5 | Yes | No | Yes |
| Community Blue Medicare Plus PPO Signature (PPO) | H3916-039 | 5 | Yes | No | Yes |
| Community Blue Medicare Plus PPO Signature (PPO) | H3916-063 | 5 | Yes | No | Yes |
| Community Blue Medicare PPO Signature (PPO) | H3916-037 | 5 | Yes | No | Yes |
| Community Blue Medicare PPO Signature (PPO) | H3916-037 | 5 | Yes | No | Yes |
| Community Blue Medicare PPO Signature (PPO) | H3916-037 | 5 | Yes | No | Yes |
| Community Blue Medicare PPO Signature (PPO) | H3916-037 | 5 | Yes | No | Yes |
| Community Blue Medicare PPO Signature (PPO) | H3916-037 | 5 | Yes | No | Yes |
| Community Blue Medicare PPO Signature (PPO) | H3916-037 | 5 | Yes | No | Yes |
| Community Blue Medicare PPO Signature (PPO) | H3916-065 | 5 | Yes | No | Yes |
| Complete Blue HMO Distinct (HMO) | H3957-050 | 5 | Yes | No | Yes |
| Complete Blue HMO Distinct (HMO) | H3957-050 | 5 | Yes | No | Yes |
| Complete Blue HMO Distinct (HMO) | H3957-050 | 5 | Yes | No | Yes |
| Complete Blue HMO Distinct (HMO) | H3957-050 | 5 | Yes | No | Yes |
| Complete Blue HMO Distinct (HMO) | H3957-050 | 5 | Yes | No | Yes |
| Complete Blue Plus PPO Distinct (PPO) | H3916-061 | 5 | Yes | No | Yes |
| Complete Blue Plus PPO Distinct (PPO) | H3916-061 | 5 | Yes | No | Yes |
| Complete Blue Plus PPO Merit (PPO) | H3916-064 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-035 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-035 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-059 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-059 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-060 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-060 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-060 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-060 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-060 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-060 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-062 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H5106-029 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H5106-029 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H5106-029 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H5106-036 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H8166-006 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H8166-007 | 5 | Yes | No | Yes |
| Complete Blue PPO Merit (PPO) | H3916-057 | 5 | Yes | No | Yes |
| Complete Blue PPO Merit (PPO) | H3916-066 | 5 | Yes | No | Yes |
| Complete Blue PPO Merit (PPO) | H5106-037 | 5 | Yes | No | Yes |
| Complete Blue PPO Signature (PPO) | H3916-038 | 5 | Yes | No | Yes |
| Complete Blue PPO Signature (PPO) | H3916-041 | 5 | Yes | No | Yes |
| Complete Blue PPO Signature (PPO) | H3916-041 | 5 | Yes | No | Yes |
| Complete Blue PPO Signature (PPO) | H3916-041 | 5 | Yes | No | Yes |
| Complete Blue PPO Signature (PPO) | H3916-058 | 5 | Yes | No | Yes |
| Complete Blue PPO Signature (PPO) | H5106-030 | 5 | Yes | No | Yes |
| Complete Blue PPO Signature (PPO) | H5106-030 | 5 | Yes | No | Yes |
| Complete Blue PPO Signature (PPO) | H5106-030 | 5 | Yes | No | Yes |
| Complete Blue PPO Signature (PPO) | H5106-035 | 5 | Yes | No | Yes |
| Complete Blue PPO Signature (PPO) | H8166-005 | 5 | Yes | No | Yes |
| Forever Blue 751 (PPO) | H5526-004 | 5 | Yes | No | Yes |
| Forever Blue 770 (PPO) | H5526-018 | 5 | Yes | No | Yes |
| Forever Blue Value (PPO) | H5526-016 | 5 | Yes | No | Yes |
| Freedom Blue PPO Classic (PPO) | H3916-001 | 5 | Yes | No | Yes |
| Freedom Blue PPO Classic (PPO) | H3916-002 | 5 | Yes | No | Yes |
| Freedom Blue PPO Deluxe (PPO) | H3916-005 | 5 | Yes | No | Yes |
| Freedom Blue PPO Select (PPO) | H3916-022 | 5 | Yes | No | Yes |
| Freedom Blue PPO Select (PPO) | H3916-024 | 5 | Yes | No | Yes |
| Freedom Blue PPO Standard (PPO) | H3916-015 | 5 | Yes | No | Yes |
| Freedom Blue PPO Standard (PPO) | H5106-034 | 5 | Yes | No | Yes |
| Freedom Blue PPO Standard (PPO) | H5106-034 | 5 | Yes | No | Yes |
| Freedom Blue PPO ValueRx (PPO) | H3916-018 | 5 | Yes | No | Yes |
| Freedom Blue PPO ValueRx (PPO) | H3916-032 | 5 | Yes | No | Yes |
| Freedom Blue PPO ValueRx (PPO) | H3916-033 | 5 | Yes | No | Yes |
| Highmark Health Options Duals (HMO D-SNP) | H6224-001 | 1 | Yes | No | Yes |
| Highmark Health Options Duals (HMO D-SNP) | H7710-001 | 1 | Yes | No | Yes |
| Highmark Health Options Duals Select (HMO D-SNP) | H7710-002 | 1 | Yes | No | Yes |
| Medicare HMO Blue FlexRx (HMO-POS) | H2261-023 | 5 | Yes | No | Yes |
| Medicare HMO Blue FlexRx (HMO-POS) | H2261-023 | 5 | Yes | No | Yes |
| Medicare HMO Blue PlusRx (HMO) | H2261-005 | 5 | Yes | No | Yes |
| Medicare HMO Blue SaverRx (HMO-POS) | H2261-024 | 5 | Yes | No | Yes |
| Medicare HMO Blue ValueRx (HMO) | H2261-022 | 5 | Yes | No | Yes |
Showing 100 of 115 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.
Uptravi 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.