Does Bravo Health Mid-Atlantic, INC. require prior authorization for Prevymis?
Bravo Health Mid-Atlantic, INC. does not require prior authorization for Prevymis 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 |
|---|---|---|---|---|---|
| letermovir 240 MG Oral Tablet [Prevymis]1988671 | 7 / 7 | 0 | 0 | 7 | No prior authorization |
| letermovir 480 MG Oral Tablet [Prevymis]1988675 | 7 / 7 | 0 | 0 | 7 | No prior authorization |
| letermovir 20 MG Oral Pellet [Prevymis]2693189 | 7 / 7 | 0 | 0 | 7 | No prior authorization |
| letermovir 120 MG Oral Pellet [Prevymis]2693193 | 7 / 7 | 0 | 0 | 7 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — letermovir 240 MG Oral Tablet [Prevymis]
Prevymis has 4 products in the corpus; this table is for letermovir 240 MG Oral Tablet [Prevymis], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| HealthSpring Achieve (HMO C-SNP) | H2108-029 | 5 | No | No | Yes |
| HealthSpring Achieve (HMO C-SNP) | H2108-030 | 5 | No | No | Yes |
| HealthSpring Alliance (HMO) | H2108-036 | 5 | No | No | Yes |
| HealthSpring Preferred (HMO) | H2108-042 | 5 | No | No | Yes |
| HealthSpring Preferred (HMO) | H2108-042 | 5 | No | No | Yes |
| HealthSpring Preferred Plus (HMO) | H2108-022 | 5 | No | No | Yes |
| HealthSpring TotalCare Plus (HMO D-SNP) | H2108-041 | 5 | No | No | Yes |
- 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.
Prevymis 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.