Does Bravo Health Pennsylvania, INC. require prior authorization for Wixela?
Bravo Health Pennsylvania, INC. does not require prior authorization for Wixela 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 |
|---|---|---|---|---|---|
| 60 ACTUAT fluticasone propionate 0.1 MG/ACTUAT / salmeterol 0.05 MG/ACTUAT Dry Powder Inhaler [Wixela]2110510 | 35 / 35 | 0 | 0 | 35 | No prior authorization |
| 60 ACTUAT fluticasone propionate 0.25 MG/ACTUAT / salmeterol 0.05 MG/ACTUAT Dry Powder Inhaler [Wixela]2110513 | 35 / 35 | 0 | 0 | 35 | No prior authorization |
| 60 ACTUAT fluticasone propionate 0.5 MG/ACTUAT / salmeterol 0.05 MG/ACTUAT Dry Powder Inhaler [Wixela]2110516 | 35 / 35 | 0 | 0 | 35 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — 60 ACTUAT fluticasone propionate 0.1 MG/ACTUAT / salmeterol 0.05 MG/ACTUAT Dry Powder Inhaler [Wixela]
Wixela has 3 products in the corpus; this table is for 60 ACTUAT fluticasone propionate 0.1 MG/ACTUAT / salmeterol 0.05 MG/ACTUAT Dry Powder Inhaler [Wixela], 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 | 2 | No | No | Yes |
| HealthSpring TotalCare Plus (HMO D-SNP) | H2752-003 | 2 | No | No | Yes |
| HealthSpring TotalCare Plus (HMO D-SNP) | H3949-009 | 2 | No | No | Yes |
| HealthSpring TotalCare Plus (HMO D-SNP) | H9725-013 | 2 | 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.
Wixela 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.