Does Bravo Health Pennsylvania, INC. require prior authorization for Dotti?
Bravo Health Pennsylvania, INC. does not require prior authorization for Dotti 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 |
|---|---|---|---|---|---|
| 84 HR estradiol 0.00104 MG/HR Transdermal System [Dotti]2110774 | 35 / 35 | 0 | 0 | 35 | No prior authorization |
| 84 HR estradiol 0.00156 MG/HR Transdermal System [Dotti]2110777 | 35 / 35 | 0 | 0 | 35 | No prior authorization |
| 84 HR estradiol 0.00208 MG/HR Transdermal System [Dotti]2110780 | 35 / 35 | 0 | 0 | 35 | No prior authorization |
| 84 HR estradiol 0.00313 MG/HR Transdermal System [Dotti]2110783 | 35 / 35 | 0 | 0 | 35 | No prior authorization |
| 84 HR estradiol 0.00417 MG/HR Transdermal System [Dotti]2110786 | 35 / 35 | 0 | 0 | 35 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — 84 HR estradiol 0.00104 MG/HR Transdermal System [Dotti]
Dotti has 5 products in the corpus; this table is for 84 HR estradiol 0.00104 MG/HR Transdermal System [Dotti], 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 | 2 | No | No | Yes |
| HealthSpring Achieve (HMO C-SNP) | H3949-024 | 2 | No | No | Yes |
| HealthSpring Alliance (HMO) | H0354-028 | 2 | No | No | Yes |
| HealthSpring Preferred (HMO) | H0354-001 | 2 | No | No | Yes |
| HealthSpring Preferred (HMO) | H3949-035 | 2 | No | No | Yes |
| HealthSpring Preferred (HMO) | H3949-045 | 2 | No | No | Yes |
| HealthSpring Preferred (HMO) | H3949-047 | 2 | No | No | Yes |
| HealthSpring Preferred (HMO) | H3949-049 | 2 | No | No | Yes |
| HealthSpring Preferred (HMO) | H3949-052 | 2 | No | No | Yes |
| HealthSpring Preferred (HMO) | H3949-054 | 2 | No | No | Yes |
| HealthSpring Preferred (HMO) | H9725-009 | 2 | No | No | Yes |
| HealthSpring Preferred (HMO) | H9725-009 | 2 | No | No | Yes |
| HealthSpring Preferred (HMO) | H9725-009 | 2 | No | No | Yes |
| HealthSpring Preferred (HMO) | H9725-009 | 2 | No | No | Yes |
| HealthSpring Preferred Full Savings (HMO) | H0354-030 | 2 | No | No | Yes |
| HealthSpring Preferred PA (HMO) | H3949-031 | 2 | No | No | Yes |
| HealthSpring Preferred Plus (HMO) | H3949-030 | 2 | No | No | Yes |
| HealthSpring Preferred Plus (HMO) | H3949-048 | 2 | No | No | Yes |
| HealthSpring Preferred Plus (HMO) | H9725-017 | 2 | No | No | Yes |
| HealthSpring Preferred Plus (HMO) | H9725-017 | 2 | No | No | Yes |
| HealthSpring Preferred Plus (HMO) | H9725-017 | 2 | No | No | Yes |
| HealthSpring Preferred Plus (HMO) | H9725-017 | 2 | No | No | Yes |
| HealthSpring Preferred Savings (HMO) | H0354-029 | 2 | No | No | Yes |
| HealthSpring Preferred Savings (HMO) | H3949-053 | 2 | No | No | Yes |
| HealthSpring Preferred Savings (HMO) | H9725-015 | 2 | No | No | Yes |
| HealthSpring Preferred Savings (HMO) | H9725-015 | 2 | No | No | Yes |
| HealthSpring Preferred Savings (HMO) | H9725-015 | 2 | No | No | Yes |
| HealthSpring Preferred Savings (HMO) | H9725-015 | 2 | No | No | Yes |
| HealthSpring Preferred Savings (HMO) | H9725-016 | 2 | No | No | Yes |
| HealthSpring Preferred Select (HMO) | H9725-014 | 2 | No | No | Yes |
| HealthSpring Premier (HMO-POS) | H9725-018 | 2 | No | No | Yes |
| HealthSpring TotalCare (HMO D-SNP) | H9725-003 | 3 | No | No | Yes |
| HealthSpring TotalCare Plus (HMO D-SNP) | H2752-003 | 3 | No | No | Yes |
| HealthSpring TotalCare Plus (HMO D-SNP) | H3949-009 | 3 | No | No | Yes |
| HealthSpring TotalCare Plus (HMO D-SNP) | H9725-013 | 3 | No | No | Yes |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
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Dotti at other payers
Or see Dotti 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.