No prior authorization
Does Centene (WellCare) require prior authorization for Spritam?
Centene (WellCare) 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.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| levetiracetam 250 MG Tablet for Oral Suspension [Spritam]1736047 | 197 / 197 | 0 | 0 | 0 | No prior authorization |
| levetiracetam 500 MG Tablet for Oral Suspension [Spritam]1736050 | 197 / 197 | 0 | 0 | 0 | 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 |
|---|---|---|---|---|---|
| Wellcare 'Ohana Dual Align (HMO-POS D-SNP) | H9916-001 | 3 | No | No | No |
| Wellcare Assist (HMO-POS) | H0913-015 | 3 | No | No | No |
| Wellcare Assist (HMO-POS) | H1112-043 | 3 | No | No | No |
| Wellcare Assist (HMO-POS) | H2491-010 | 3 | No | No | No |
| Wellcare Assist (HMO-POS) | H4847-005 | 3 | No | No | No |
| Wellcare Assist (HMO-POS) | H9730-010 | 3 | No | No | No |
| Wellcare Assist (HMO) | H0174-009 | 3 | No | No | No |
| Wellcare Assist Open (PPO) | H1914-009 | 3 | No | No | No |
| Wellcare Assist Open (PPO) | H7326-007 | 3 | No | No | No |
| Wellcare CalViva Health Dual Align (HMO D-SNP) | H3561-007 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-012 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-013 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-014 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-020 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-021 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-069 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-070 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-071 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-072 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-073 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-074 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-075 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-076 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-077 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-078 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-079 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-080 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-081 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-082 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-083 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-084 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-085 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-086 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-087 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-088 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-089 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-090 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-091 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-092 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-093 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-094 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-095 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-096 | 3 | No | No | No |
| Wellcare Classic (PDP) | S4802-097 | 3 | No | No | No |
| Wellcare Dual Access (HMO D-SNP) | H0174-004 | 3 | No | No | No |
| Wellcare Dual Access (HMO-POS D-SNP) | H0351-066 | 3 | No | No | No |
| Wellcare Dual Access (HMO-POS D-SNP) | H0351-068 | 3 | No | No | No |
| Wellcare Dual Access (HMO-POS D-SNP) | H0712-005 | 3 | No | No | No |
| Wellcare Dual Access (HMO-POS D-SNP) | H1112-006 | 3 | No | No | No |
| Wellcare Dual Access (HMO-POS D-SNP) | H1112-047 | 3 | No | No | No |
| Wellcare Dual Access (HMO-POS D-SNP) | H1862-004 | 3 | No | No | No |
| Wellcare Dual Access (HMO-POS D-SNP) | H2491-033 | 3 | No | No | No |
| Wellcare Dual Access (HMO-POS D-SNP) | H2491-033 | 3 | No | No | No |
| Wellcare Dual Access (HMO-POS D-SNP) | H4073-002 | 3 | No | No | No |
| Wellcare Dual Access (HMO-POS D-SNP) | H9364-002 | 3 | No | No | No |
| Wellcare Dual Access Open (PPO D-SNP) | H0074-004 | 3 | No | No | No |
| Wellcare Dual Access Open (PPO D-SNP) | H0111-004 | 3 | No | No | No |
| Wellcare Dual Access Open (PPO D-SNP) | H4537-004 | 3 | No | No | No |
| Wellcare Dual Access Open (PPO D-SNP) | H5965-006 | 3 | No | No | No |
| Wellcare Dual Access Open (PPO D-SNP) | H7518-003 | 3 | No | No | No |
| Wellcare Dual Access Sync (HMO-POS D-SNP) | H9730-003 | 3 | No | No | No |
| Wellcare Dual Access Sync Open (PPO D-SNP) | H3975-004 | 3 | No | No | No |
| Wellcare Dual Liberty (HMO D-SNP) | H0174-006 | 3 | No | No | No |
| Wellcare Dual Liberty (HMO D-SNP) | H0712-029 | 3 | No | No | No |
| Wellcare Dual Liberty (HMO-POS D-SNP) | H1112-033 | 3 | No | No | No |
| Wellcare Dual Liberty (HMO-POS D-SNP) | H2491-032 | 3 | No | No | No |
| Wellcare Dual Liberty (HMO-POS D-SNP) | H2491-032 | 3 | No | No | No |
| Wellcare Dual Liberty (HMO-POS D-SNP) | H4073-004 | 3 | No | No | No |
| Wellcare Dual Liberty (HMO-POS D-SNP) | H9364-003 | 3 | No | No | No |
| Wellcare Dual Liberty Open (PPO D-SNP) | H1914-008 | 3 | No | No | No |
| Wellcare Dual Liberty Sync (HMO D-SNP) | H0174-023 | 3 | No | No | No |
| Wellcare Dual Liberty Sync (HMO D-SNP) | H0174-024 | 3 | No | No | No |
| Wellcare Dual Liberty Sync (HMO D-SNP) | H0174-025 | 3 | No | No | No |
| Wellcare Dual Liberty Sync (HMO D-SNP) | H0174-026 | 3 | No | No | No |
| Wellcare Dual Liberty Sync (HMO-POS D-SNP) | H1862-003 | 3 | No | No | No |
| Wellcare Dual Liberty Sync (HMO-POS D-SNP) | H9730-004 | 3 | No | No | No |
| Wellcare Dual Liberty Sync Open (PPO D-SNP) | H5965-004 | 3 | No | No | No |
| Wellcare Dual Reserve (HMO D-SNP) | H0174-022 | 3 | No | No | No |
| Wellcare Dual Reserve (HMO-POS D-SNP) | H1112-046 | 3 | No | No | No |
| Wellcare Dual Reserve (HMO-POS D-SNP) | H1112-048 | 3 | No | No | No |
| Wellcare Dual Reserve (HMO-POS D-SNP) | H1862-006 | 3 | No | No | No |
| Wellcare Dual Reserve (HMO-POS D-SNP) | H2491-025 | 3 | No | No | No |
| Wellcare Dual Reserve (HMO-POS D-SNP) | H4073-003 | 3 | No | No | No |
| Wellcare Dual Reserve (HMO-POS D-SNP) | H9730-011 | 3 | No | No | No |
| Wellcare Fidelis Dual Align (HMO D-SNP) | H0913-013 | 3 | No | No | No |
| Wellcare Giveback (HMO-POS) | H0712-032 | 3 | No | No | No |
| Wellcare Giveback (HMO-POS) | H0913-021 | 3 | No | No | No |
| Wellcare Giveback (HMO-POS) | H1112-042 | 3 | No | No | No |
| Wellcare Giveback (HMO-POS) | H2491-031 | 3 | No | No | No |
| Wellcare Giveback (HMO-POS) | H4847-007 | 3 | No | No | No |
| Wellcare Giveback (HMO-POS) | H9364-004 | 3 | No | No | No |
| Wellcare Giveback (HMO-POS) | H9730-007 | 3 | No | No | No |
| Wellcare Giveback (HMO) | H0174-017 | 3 | No | No | No |
| Wellcare Giveback (HMO) | H0174-018 | 3 | No | No | No |
| Wellcare Giveback (HMO) | H0174-019 | 3 | No | No | No |
| Wellcare Giveback (HMO) | H0174-020 | 3 | No | No | No |
| Wellcare Giveback (HMO) | H0174-021 | 3 | No | No | No |
| Wellcare Giveback (HMO) | H0351-054 | 3 | No | No | No |
| Wellcare Giveback (HMO) | H0351-064 | 3 | No | No | No |
| Wellcare Giveback (HMO) | H5087-032 | 3 | No | No | No |
Showing 100 of 197 covering plans.
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.
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.