Does Bravo Health Pennsylvania, INC. require prior authorization for Diacomit?
Bravo Health Pennsylvania, INC. does not require prior authorization for Diacomit 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 product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| stiripentol 250 MG Oral Capsule [Diacomit]2054979 | 35 / 35 | 0 | 0 | 0 | No prior authorization |
| stiripentol 500 MG Oral Capsule [Diacomit]2054983 | 35 / 35 | 0 | 0 | 0 | No prior authorization |
| stiripentol 500 MG Powder for Oral Suspension [Diacomit]2055014 | 35 / 35 | 0 | 0 | 0 | No prior authorization |
| stiripentol 250 MG Powder for Oral Suspension [Diacomit]2055016 | 0 / 35 | 0 | 0 | 0 | Not on formulary |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — stiripentol 250 MG Oral Capsule [Diacomit]
Diacomit has 4 products in the corpus; this table is for stiripentol 250 MG Oral Capsule [Diacomit], 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) | H0354-027 | 5 | No | No | No |
| HealthSpring Achieve (HMO C-SNP) | H3949-024 | 5 | No | No | No |
| HealthSpring Alliance (HMO) | H0354-028 | 5 | No | No | No |
| HealthSpring Preferred (HMO) | H0354-001 | 5 | No | No | No |
| HealthSpring Preferred (HMO) | H3949-035 | 5 | No | No | No |
| HealthSpring Preferred (HMO) | H3949-045 | 5 | No | No | No |
| HealthSpring Preferred (HMO) | H3949-047 | 5 | No | No | No |
| HealthSpring Preferred (HMO) | H3949-049 | 5 | No | No | No |
| HealthSpring Preferred (HMO) | H3949-052 | 5 | No | No | No |
| HealthSpring Preferred (HMO) | H3949-054 | 5 | No | No | No |
| HealthSpring Preferred (HMO) | H9725-009 | 5 | No | No | No |
| HealthSpring Preferred (HMO) | H9725-009 | 5 | No | No | No |
| HealthSpring Preferred (HMO) | H9725-009 | 5 | No | No | No |
| HealthSpring Preferred (HMO) | H9725-009 | 5 | No | No | No |
| HealthSpring Preferred Full Savings (HMO) | H0354-030 | 5 | No | No | No |
| HealthSpring Preferred PA (HMO) | H3949-031 | 5 | No | No | No |
| HealthSpring Preferred Plus (HMO) | H3949-030 | 5 | No | No | No |
| HealthSpring Preferred Plus (HMO) | H3949-048 | 5 | No | No | No |
| HealthSpring Preferred Plus (HMO) | H9725-017 | 5 | No | No | No |
| HealthSpring Preferred Plus (HMO) | H9725-017 | 5 | No | No | No |
| HealthSpring Preferred Plus (HMO) | H9725-017 | 5 | No | No | No |
| HealthSpring Preferred Plus (HMO) | H9725-017 | 5 | No | No | No |
| HealthSpring Preferred Savings (HMO) | H0354-029 | 5 | No | No | No |
| HealthSpring Preferred Savings (HMO) | H3949-053 | 5 | No | No | No |
| HealthSpring Preferred Savings (HMO) | H9725-015 | 5 | No | No | No |
| HealthSpring Preferred Savings (HMO) | H9725-015 | 5 | No | No | No |
| HealthSpring Preferred Savings (HMO) | H9725-015 | 5 | No | No | No |
| HealthSpring Preferred Savings (HMO) | H9725-015 | 5 | No | No | No |
| HealthSpring Preferred Savings (HMO) | H9725-016 | 5 | No | No | No |
| HealthSpring Preferred Select (HMO) | H9725-014 | 5 | No | No | No |
| HealthSpring Premier (HMO-POS) | H9725-018 | 5 | No | No | No |
| HealthSpring TotalCare (HMO D-SNP) | H9725-003 | 5 | No | No | No |
| HealthSpring TotalCare Plus (HMO D-SNP) | H2752-003 | 5 | No | No | No |
| HealthSpring TotalCare Plus (HMO D-SNP) | H3949-009 | 5 | No | No | No |
| HealthSpring TotalCare Plus (HMO D-SNP) | H9725-013 | 5 | No | No | No |
- 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.
Diacomit 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.