Benefily
No prior authorization

Does Bluecross Blueshield Of Tennessee, INC. require prior authorization for Kaletra?

Bluecross Blueshield Of Tennessee, INC. does not require prior authorization for Kaletra on the Medicare Part D plans that cover it.

No covering plan from this payer files a prior-authorization requirement for this drug.

  • This drug does not appear on any of this payer's Medicare Part D formularies. That means it is NOT COVERED under those plans — which is a different and generally worse outcome than requiring prior authorization. An exception or formulary-exception request may still be possible.

By product strength

RxNorm productPlans coveringRequire prior authStep therapyQty limitStatus
lopinavir 200 MG / ritonavir 50 MG Oral Tablet [Kaletra]8477410 / 17000Not on formulary
lopinavir 100 MG / ritonavir 25 MG Oral Tablet [Kaletra]8477450 / 17000Not on formulary
lopinavir 80 MG/ML / ritonavir 20 MG/ML Oral Solution [Kaletra]84774917 / 170017No prior authorization

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

Plan-by-plan detail — lopinavir 80 MG/ML / ritonavir 20 MG/ML Oral Solution [Kaletra]

Kaletra has 3 products in the corpus; this table is for lopinavir 80 MG/ML / ritonavir 20 MG/ML Oral Solution [Kaletra], the one carried on the most plans. The product table above covers every strength.

PlanContractTierPrior authStep therapyQty limit
BlueAdvantage Diamond (PPO)H7917-0094NoNoYes
BlueAdvantage Diamond (PPO)H7917-0104NoNoYes
BlueAdvantage Diamond (PPO)H7917-0114NoNoYes
BlueAdvantage Extra (PPO)H7917-0414NoNoYes
BlueAdvantage Garnet (PPO)H7917-0324NoNoYes
BlueAdvantage Garnet (PPO)H7917-0334NoNoYes
BlueAdvantage Ruby (PPO)H7917-0124NoNoYes
BlueAdvantage Ruby (PPO)H7917-0134NoNoYes
BlueAdvantage Ruby (PPO)H7917-0144NoNoYes
BlueAdvantage Ruby (PPO)H7917-0154NoNoYes
BlueAdvantage Sapphire (PPO)H7917-0304NoNoYes
BlueAdvantage Sapphire (PPO)H7917-0314NoNoYes
BlueAdvantage Sapphire (PPO)H7917-0384NoNoYes
BlueAdvantage Sapphire (PPO)H7917-0404NoNoYes
BlueAdvantage Total Heart and Diabetes (PPO C-SNP)H7917-0444NoNoYes
BlueAdvantage Total Heart and Diabetes (PPO C-SNP)H7917-0454NoNoYes
BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP)H7917-0464NoNoYes
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.

Kaletra at other payers

Or see Kaletra 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.