Prior authorization required

Does Cariten Health Plan INC. require prior authorization for Pegasys?

Cariten Health Plan INC. requires prior authorization for Pegasys 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	Step therapy	Qty limit	Status
1 ML peginterferon alfa-2a 0.18 MG/ML Injection [Pegasys]352297	44 / 44	44	0	44	Prior authorization required
0.5 ML peginterferon alfa-2a 0.36 MG/ML Prefilled Syringe [Pegasys]731328	44 / 44	44	0	44	Prior authorization required

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

Plan-by-plan detail — 1 ML peginterferon alfa-2a 0.18 MG/ML Injection [Pegasys]

Pegasys has 2 products in the corpus; this table is for 1 ML peginterferon alfa-2a 0.18 MG/ML Injection [Pegasys], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
Humana Community (HMO-POS)	H4461-048	5	Yes	No	Yes
Humana Dual Select H4461-077 (HMO D-SNP)	H4461-077	5	Yes	No	Yes
Humana Essentials Plus Giveback H4461-039 (HMO)	H4461-039	5	Yes	No	Yes
Humana Essentials Plus Giveback H4461-045 (HMO)	H4461-045	5	Yes	No	Yes
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	H4461-042	5	Yes	No	Yes
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	H4461-063	5	Yes	No	Yes
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	H4461-065	5	Yes	No	Yes
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	H4461-066	5	Yes	No	Yes
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	H4461-067	5	Yes	No	Yes
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	H4461-068	5	Yes	No	Yes
Humana Gold Plus H4461-025 (HMO)	H4461-025	5	Yes	No	Yes
Humana Gold Plus H4461-035 (HMO)	H4461-035	5	Yes	No	Yes
Humana Gold Plus H4461-040 (HMO)	H4461-040	5	Yes	No	Yes
Humana Gold Plus H4461-041 (HMO)	H4461-041	5	Yes	No	Yes
Humana Gold Plus H4461-050 (HMO)	H4461-050	5	Yes	No	Yes
Humana Gold Plus H4461-052 (HMO)	H4461-052	5	Yes	No	Yes
Humana Gold Plus H4461-053 (HMO)	H4461-053	5	Yes	No	Yes
Humana Gold Plus H4461-054 (HMO)	H4461-054	5	Yes	No	Yes
Humana Gold Plus H4461-055 (HMO)	H4461-055	5	Yes	No	Yes
Humana Gold Plus H4461-056 (HMO)	H4461-056	5	Yes	No	Yes
Humana Gold Plus H4461-057 (HMO)	H4461-057	5	Yes	No	Yes
Humana Gold Plus H4461-058 (HMO)	H4461-058	5	Yes	No	Yes
Humana Gold Plus H4461-059 (HMO)	H4461-059	5	Yes	No	Yes
Humana Gold Plus H4461-060 (HMO)	H4461-060	5	Yes	No	Yes
Humana Gold Plus H4461-061 (HMO)	H4461-061	5	Yes	No	Yes
Humana Gold Plus H4461-062 (HMO)	H4461-062	5	Yes	No	Yes
Humana Gold Plus H4461-073 (HMO)	H4461-073	5	Yes	No	Yes
Humana Gold Plus H4461-078 (HMO)	H4461-078	5	Yes	No	Yes
Humana Gold Plus H4461-079 (HMO)	H4461-079	5	Yes	No	Yes
Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP)	H4461-038	5	Yes	No	Yes
Humana Gold Plus SNP-DE H4461-044 (HMO-POS D-SNP)	H4461-044	5	Yes	No	Yes
Humana Gold Plus SNP-DE H4461-069 (HMO D-SNP)	H4461-069	5	Yes	No	Yes
Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP)	H4461-070	5	Yes	No	Yes
Humana Gold Plus SNP-DE H4461-071 (HMO D-SNP)	H4461-071	5	Yes	No	Yes
Humana Gold Plus SNP-DE H4461-072 (HMO D-SNP)	H4461-072	5	Yes	No	Yes
Humana Gold Plus SNP-DE H4461-074 (HMO D-SNP)	H4461-074	5	Yes	No	Yes
Humana Gold Plus SNP-DE H4461-076 (HMO D-SNP)	H4461-076	5	Yes	No	Yes
Humana Total Complete Giveback H4461-047 (HMO-POS)	H4461-047	5	Yes	No	Yes
Humana Total Complete H4461-043 (HMO)	H4461-043	5	Yes	No	Yes
Humana Total Complete H4461-043 (HMO)	H4461-043	5	Yes	No	Yes
Humana Total Complete H4461-046 (HMO)	H4461-046	5	Yes	No	Yes
Humana Total Complete H4461-049 (HMO)	H4461-049	5	Yes	No	Yes
Humana Total Complete H4461-051 (HMO)	H4461-051	5	Yes	No	Yes
Humana Total Complete H4461-064 (HMO)	H4461-064	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.

Pegasys at other payers

Or see Pegasys 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.