Prior authorization required

Does California Physicians' Service require prior authorization for Envarsus?

California Physicians' Service requires prior authorization for Envarsus on every Medicare Part D plan of theirs that covers it.

Every plan from this payer that covers the drug requires authorization before it is dispensed.

By product strength

RxNorm product	Plans covering	Require prior auth	Status
24 HR tacrolimus 4 MG Extended Release Oral Tablet [Envarsus]1664440	17 / 17	17	Prior authorization required
24 HR tacrolimus 0.75 MG Extended Release Oral Tablet [Envarsus]1664458	17 / 17	17	Prior authorization required
24 HR tacrolimus 1 MG Extended Release Oral Tablet [Envarsus]1664463	17 / 17	17	Prior authorization required

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

Plan-by-plan detail — 24 HR tacrolimus 4 MG Extended Release Oral Tablet [Envarsus]

Envarsus has 3 products in the corpus; this table is for 24 HR tacrolimus 4 MG Extended Release Oral Tablet [Envarsus], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
Blue Shield 65 Plus (HMO)	H0504-015	4	Yes	No	No
Blue Shield 65 Plus (HMO)	H0504-017	4	Yes	No	No
Blue Shield 65 Plus (HMO)	H0504-026	4	Yes	No	No
Blue Shield 65 Plus (HMO)	H0504-028	4	Yes	No	No
Blue Shield 65 Plus (HMO)	H0504-038	4	Yes	No	No
Blue Shield 65 Plus (HMO)	H0504-039	4	Yes	No	No
Blue Shield 65 Plus Choice Plan (HMO)	H0504-040	4	Yes	No	No
Blue Shield 65 Plus Plan 2 (HMO)	H0504-021	4	Yes	No	No
Blue Shield Advantage (HMO)	H0504-050	4	Yes	No	No
Blue Shield AdvantageOptimum Plan (HMO)	H5928-004	4	Yes	No	No
Blue Shield AdvantageOptimum Plan 1 (HMO)	H5928-010	4	Yes	No	No
Blue Shield Inspire (HMO)	H0504-041	4	Yes	No	No
Blue Shield Inspire (HMO)	H0504-043	4	Yes	No	No
Blue Shield Inspire (HMO)	H0504-047	4	Yes	No	No
Blue Shield Rx Enhanced (PDP)	S2468-004	4	Yes	No	No
Blue Shield Rx Plus (PDP)	S2468-003	4	Yes	No	No
Blue Shield TotalDual Plan (HMO D-SNP)	H2819-001	4	Yes	No	No

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.

Envarsus at other payers

Or see Envarsus 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.