Does Cariten Health Plan INC. require prior authorization for Spritam?
Cariten Health Plan INC. does not require prior authorization for Spritam on the Medicare Part D plans that cover it.
No covering plan from this payer files a prior-authorization requirement for this drug.
- No prior authorization is filed, but step therapy applies on 44 of 44 covering plans — the plan requires another drug be tried first.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| levetiracetam 250 MG Tablet for Oral Suspension [Spritam]1736047 | 44 / 44 | 0 | 44 | 44 | No prior authorization |
| levetiracetam 500 MG Tablet for Oral Suspension [Spritam]1736050 | 44 / 44 | 0 | 44 | 44 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — levetiracetam 250 MG Tablet for Oral Suspension [Spritam]
Spritam has 2 products in the corpus; this table is for levetiracetam 250 MG Tablet for Oral Suspension [Spritam], 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 | 4 | No | Yes | Yes |
| Humana Dual Select H4461-077 (HMO D-SNP) | H4461-077 | 4 | No | Yes | Yes |
| Humana Essentials Plus Giveback H4461-039 (HMO) | H4461-039 | 4 | No | Yes | Yes |
| Humana Essentials Plus Giveback H4461-045 (HMO) | H4461-045 | 4 | No | Yes | Yes |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | H4461-042 | 4 | No | Yes | Yes |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | H4461-063 | 4 | No | Yes | Yes |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | H4461-065 | 4 | No | Yes | Yes |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | H4461-066 | 4 | No | Yes | Yes |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | H4461-067 | 4 | No | Yes | Yes |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | H4461-068 | 4 | No | Yes | Yes |
| Humana Gold Plus H4461-025 (HMO) | H4461-025 | 4 | No | Yes | Yes |
| Humana Gold Plus H4461-035 (HMO) | H4461-035 | 4 | No | Yes | Yes |
| Humana Gold Plus H4461-040 (HMO) | H4461-040 | 4 | No | Yes | Yes |
| Humana Gold Plus H4461-041 (HMO) | H4461-041 | 4 | No | Yes | Yes |
| Humana Gold Plus H4461-050 (HMO) | H4461-050 | 4 | No | Yes | Yes |
| Humana Gold Plus H4461-052 (HMO) | H4461-052 | 4 | No | Yes | Yes |
| Humana Gold Plus H4461-053 (HMO) | H4461-053 | 4 | No | Yes | Yes |
| Humana Gold Plus H4461-054 (HMO) | H4461-054 | 4 | No | Yes | Yes |
| Humana Gold Plus H4461-055 (HMO) | H4461-055 | 4 | No | Yes | Yes |
| Humana Gold Plus H4461-056 (HMO) | H4461-056 | 4 | No | Yes | Yes |
| Humana Gold Plus H4461-057 (HMO) | H4461-057 | 4 | No | Yes | Yes |
| Humana Gold Plus H4461-058 (HMO) | H4461-058 | 4 | No | Yes | Yes |
| Humana Gold Plus H4461-059 (HMO) | H4461-059 | 4 | No | Yes | Yes |
| Humana Gold Plus H4461-060 (HMO) | H4461-060 | 4 | No | Yes | Yes |
| Humana Gold Plus H4461-061 (HMO) | H4461-061 | 4 | No | Yes | Yes |
| Humana Gold Plus H4461-062 (HMO) | H4461-062 | 4 | No | Yes | Yes |
| Humana Gold Plus H4461-073 (HMO) | H4461-073 | 4 | No | Yes | Yes |
| Humana Gold Plus H4461-078 (HMO) | H4461-078 | 4 | No | Yes | Yes |
| Humana Gold Plus H4461-079 (HMO) | H4461-079 | 4 | No | Yes | Yes |
| Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP) | H4461-038 | 4 | No | Yes | Yes |
| Humana Gold Plus SNP-DE H4461-044 (HMO-POS D-SNP) | H4461-044 | 4 | No | Yes | Yes |
| Humana Gold Plus SNP-DE H4461-069 (HMO D-SNP) | H4461-069 | 4 | No | Yes | Yes |
| Humana Gold Plus SNP-DE H4461-070 (HMO D-SNP) | H4461-070 | 4 | No | Yes | Yes |
| Humana Gold Plus SNP-DE H4461-071 (HMO D-SNP) | H4461-071 | 4 | No | Yes | Yes |
| Humana Gold Plus SNP-DE H4461-072 (HMO D-SNP) | H4461-072 | 4 | No | Yes | Yes |
| Humana Gold Plus SNP-DE H4461-074 (HMO D-SNP) | H4461-074 | 4 | No | Yes | Yes |
| Humana Gold Plus SNP-DE H4461-076 (HMO D-SNP) | H4461-076 | 4 | No | Yes | Yes |
| Humana Total Complete Giveback H4461-047 (HMO-POS) | H4461-047 | 4 | No | Yes | Yes |
| Humana Total Complete H4461-043 (HMO) | H4461-043 | 4 | No | Yes | Yes |
| Humana Total Complete H4461-043 (HMO) | H4461-043 | 4 | No | Yes | Yes |
| Humana Total Complete H4461-046 (HMO) | H4461-046 | 4 | No | Yes | Yes |
| Humana Total Complete H4461-049 (HMO) | H4461-049 | 4 | No | Yes | Yes |
| Humana Total Complete H4461-051 (HMO) | H4461-051 | 4 | No | Yes | Yes |
| Humana Total Complete H4461-064 (HMO) | H4461-064 | 4 | No | Yes | 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.
Spritam 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.