Varies by plan

Does Bravo Health Pennsylvania, INC. require prior authorization for Xalkori?

Prior authorization for Xalkori differs across Bravo Health Pennsylvania, INC.'s Medicare Part D plans and product strengths — 3 of 5 Xalkori products in the corpus appear on their formularies, and the requirement is not uniform. Check the member's specific plan.

Some plans require authorization and others do not. The member's specific plan decides.

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	Qty limit	Status
crizotinib 200 MG Oral Capsule [Xalkori]1148502	35 / 35	35	35	Prior authorization required
crizotinib 250 MG Oral Capsule [Xalkori]1148506	35 / 35	35	35	Prior authorization required
crizotinib 150 MG Oral Pellet [Xalkori]2670170	35 / 35	35	35	Prior authorization required
crizotinib 20 MG Oral Pellet [Xalkori]2670174	0 / 35	0	0	Not on formulary
crizotinib 50 MG Oral Pellet [Xalkori]2670178	0 / 35	0	0	Not on formulary

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

Plan-by-plan detail — crizotinib 200 MG Oral Capsule [Xalkori]

Xalkori has 5 products in the corpus; this table is for crizotinib 200 MG Oral Capsule [Xalkori], 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	Yes	No	Yes
HealthSpring Achieve (HMO C-SNP)	H3949-024	5	Yes	No	Yes
HealthSpring Alliance (HMO)	H0354-028	5	Yes	No	Yes
HealthSpring Preferred (HMO)	H0354-001	5	Yes	No	Yes
HealthSpring Preferred (HMO)	H3949-035	5	Yes	No	Yes
HealthSpring Preferred (HMO)	H3949-045	5	Yes	No	Yes
HealthSpring Preferred (HMO)	H3949-047	5	Yes	No	Yes
HealthSpring Preferred (HMO)	H3949-049	5	Yes	No	Yes
HealthSpring Preferred (HMO)	H3949-052	5	Yes	No	Yes
HealthSpring Preferred (HMO)	H3949-054	5	Yes	No	Yes
HealthSpring Preferred (HMO)	H9725-009	5	Yes	No	Yes
HealthSpring Preferred (HMO)	H9725-009	5	Yes	No	Yes
HealthSpring Preferred (HMO)	H9725-009	5	Yes	No	Yes
HealthSpring Preferred (HMO)	H9725-009	5	Yes	No	Yes
HealthSpring Preferred Full Savings (HMO)	H0354-030	5	Yes	No	Yes
HealthSpring Preferred PA (HMO)	H3949-031	5	Yes	No	Yes
HealthSpring Preferred Plus (HMO)	H3949-030	5	Yes	No	Yes
HealthSpring Preferred Plus (HMO)	H3949-048	5	Yes	No	Yes
HealthSpring Preferred Plus (HMO)	H9725-017	5	Yes	No	Yes
HealthSpring Preferred Plus (HMO)	H9725-017	5	Yes	No	Yes
HealthSpring Preferred Plus (HMO)	H9725-017	5	Yes	No	Yes
HealthSpring Preferred Plus (HMO)	H9725-017	5	Yes	No	Yes
HealthSpring Preferred Savings (HMO)	H0354-029	5	Yes	No	Yes
HealthSpring Preferred Savings (HMO)	H3949-053	5	Yes	No	Yes
HealthSpring Preferred Savings (HMO)	H9725-015	5	Yes	No	Yes
HealthSpring Preferred Savings (HMO)	H9725-015	5	Yes	No	Yes
HealthSpring Preferred Savings (HMO)	H9725-015	5	Yes	No	Yes
HealthSpring Preferred Savings (HMO)	H9725-015	5	Yes	No	Yes
HealthSpring Preferred Savings (HMO)	H9725-016	5	Yes	No	Yes
HealthSpring Preferred Select (HMO)	H9725-014	5	Yes	No	Yes
HealthSpring Premier (HMO-POS)	H9725-018	5	Yes	No	Yes
HealthSpring TotalCare (HMO D-SNP)	H9725-003	5	Yes	No	Yes
HealthSpring TotalCare Plus (HMO D-SNP)	H2752-003	5	Yes	No	Yes
HealthSpring TotalCare Plus (HMO D-SNP)	H3949-009	5	Yes	No	Yes
HealthSpring TotalCare Plus (HMO D-SNP)	H9725-013	5	Yes	No	Yes

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.

Xalkori at other payers

Or see Xalkori 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.