Varies by plan

Does Capital Advantage Insurance Company require prior authorization for Somavert?

Prior authorization for Somavert differs across Capital Advantage Insurance Company's Medicare Part D plans and product strengths — 3 of 5 Somavert 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	Status
pegvisomant 30 MG Injection [Somavert]1549454	23 / 23	23	Prior authorization required
pegvisomant 25 MG Injection [Somavert]1549456	23 / 23	23	Prior authorization required
pegvisomant 10 MG Injection [Somavert]404457	23 / 23	23	Prior authorization required
pegvisomant 15 MG Injection [Somavert]404458	0 / 23	0	Not on formulary
pegvisomant 20 MG Injection [Somavert]404459	0 / 23	0	Not on formulary

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

Plan-by-plan detail — pegvisomant 30 MG Injection [Somavert]

Somavert has 5 products in the corpus; this table is for pegvisomant 30 MG Injection [Somavert], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
Capital Blue Cross Basic (PPO)	H3923-048	5	Yes	No	No
Capital Blue Cross Basic (PPO)	H3923-048	5	Yes	No	No
Capital Blue Cross Basic (PPO)	H3923-048	5	Yes	No	No
Capital Blue Cross Classic (PPO)	H3923-013	5	Yes	No	No
Capital Blue Cross Complete (PPO)	H3923-047	5	Yes	No	No
Capital Blue Cross Complete (PPO)	H3923-047	5	Yes	No	No
Capital Blue Cross Complete (PPO)	H3923-047	5	Yes	No	No
Capital Blue Cross Complete (PPO)	H3923-047	5	Yes	No	No
Capital Blue Cross Complete (PPO)	H3923-047	5	Yes	No	No
Capital Blue Cross Enhanced (PPO)	H3923-046	5	Yes	No	No
Capital Blue Cross Enhanced (PPO)	H3923-046	5	Yes	No	No
Capital Blue Cross Enhanced (PPO)	H3923-046	5	Yes	No	No
Capital Blue Cross Enhanced (PPO)	H3923-046	5	Yes	No	No
Capital Blue Cross Prime (PPO)	H3923-017	5	Yes	No	No
Capital Blue Cross Select (PPO)	H3923-044	5	Yes	No	No
Capital Blue Cross Select (PPO)	H3923-044	5	Yes	No	No
Capital Blue Cross Select (PPO)	H3923-044	5	Yes	No	No
Capital Blue Cross Select (PPO)	H3923-044	5	Yes	No	No
Capital Blue Cross Value (PPO)	H3923-045	5	Yes	No	No
Capital Blue Cross Value (PPO)	H3923-045	5	Yes	No	No
Capital Blue Cross Value (PPO)	H3923-045	5	Yes	No	No
Capital Blue Cross Value (PPO)	H3923-045	5	Yes	No	No
Capital Blue Cross Value (PPO)	H3923-045	5	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.

Somavert at other payers

Or see Somavert 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.