Does Champion Health Plan Of Nevada, INC. require prior authorization for Diacomit?
Prior authorization for Diacomit differs across Champion Health Plan Of Nevada, INC.'s Medicare Part D plans and product strengths — 3 of 4 Diacomit 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 | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| stiripentol 250 MG Oral Capsule [Diacomit]2054979 | 7 / 7 | 7 | 0 | 7 | Prior authorization required |
| stiripentol 500 MG Oral Capsule [Diacomit]2054983 | 7 / 7 | 7 | 0 | 7 | Prior authorization required |
| stiripentol 500 MG Powder for Oral Suspension [Diacomit]2055014 | 7 / 7 | 7 | 0 | 7 | Prior authorization required |
| stiripentol 250 MG Powder for Oral Suspension [Diacomit]2055016 | 0 / 7 | 0 | 0 | 0 | Not on formulary |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — stiripentol 250 MG Oral Capsule [Diacomit]
Diacomit has 4 products in the corpus; this table is for stiripentol 250 MG Oral Capsule [Diacomit], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Champion Advantage (HMO-POS C-SNP) | H6474-001 | 5 | Yes | No | Yes |
| Champion Ally (HMO) | H6474-007 | 5 | Yes | No | Yes |
| Champion Care (HMO C-SNP) | H6474-008 | 5 | Yes | No | Yes |
| Champion Choice (HMO C-SNP) | H6474-009 | 5 | Yes | No | Yes |
| Champion Connect (HMO-POS C-SNP) | H6474-002 | 5 | Yes | No | Yes |
| Champion Plus (HMO C-SNP) | H6474-010 | 5 | Yes | No | Yes |
| Champion Select (HMO-POS C-SNP) | H6474-003 | 5 | Yes | No | 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.
Diacomit 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.