Varies by plan
Does Cigna require prior authorization for Retevmo?
Prior authorization for Retevmo differs across Cigna's Medicare Part D plans and product strengths — 3 of 4 Retevmo 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 |
|---|---|---|---|---|---|
| selpercatinib 120 MG Oral Tablet [Retevmo]2679808 | 171 / 171 | 171 | 0 | 171 | Prior authorization required |
| selpercatinib 160 MG Oral Tablet [Retevmo]2679812 | 171 / 171 | 171 | 0 | 171 | Prior authorization required |
| selpercatinib 40 MG Oral Tablet [Retevmo]2679814 | 171 / 171 | 171 | 0 | 171 | Prior authorization required |
| selpercatinib 80 MG Oral Tablet [Retevmo]2679816 | 0 / 171 | 0 | 0 | 0 | Not on formulary |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — selpercatinib 120 MG Oral Tablet [Retevmo]
Retevmo has 4 products in the corpus; this table is for selpercatinib 120 MG Oral Tablet [Retevmo], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| HealthSpring Achieve (HMO C-SNP) | H4407-034 | 5 | Yes | No | Yes |
| HealthSpring Achieve (HMO C-SNP) | H4513-094 | 5 | Yes | No | Yes |
| HealthSpring Achieve (HMO C-SNP) | H4513-097 | 5 | Yes | No | Yes |
| HealthSpring Achieve (HMO C-SNP) | H4513-098 | 5 | Yes | No | Yes |
| HealthSpring Alliance (HMO) | H4513-064 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H0439-008 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H0439-009 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H0439-010 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H0439-011 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H0439-013 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H0439-015 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H0439-015 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H0439-020 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H0672-005 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H0672-006 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H0672-013 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H0672-024 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4407-030 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4407-030 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4407-030 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4407-033 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4407-035 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-026 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-030 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-037 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-038 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-049 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-049 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-049 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-049 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-049 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-050 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-052 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-061 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-061 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-061 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-061 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-061 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-074 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-077 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-077 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-077 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-077 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H4513-085 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H5410-018 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H5410-024 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H5410-059 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H5410-060 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H7020-011 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H7020-011 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H7020-011 | 5 | Yes | No | Yes |
| HealthSpring Preferred (HMO) | H9460-001 | 5 | Yes | No | Yes |
| HealthSpring Preferred AL (HMO) | H4513-046 | 5 | Yes | No | Yes |
| HealthSpring Preferred AL (HMO) | H4513-046 | 5 | Yes | No | Yes |
| HealthSpring Preferred Full Savings (HMO) | H4513-088 | 5 | Yes | No | Yes |
| HealthSpring Preferred Full Savings (HMO) | H4513-089 | 5 | Yes | No | Yes |
| HealthSpring Preferred Full Savings (HMO) | H4513-090 | 5 | Yes | No | Yes |
| HealthSpring Preferred Full Savings (HMO) | H4513-091 | 5 | Yes | No | Yes |
| HealthSpring Preferred Full Savings (HMO) | H4513-092 | 5 | Yes | No | Yes |
| HealthSpring Preferred Full Savings (HMO) | H4513-093 | 5 | Yes | No | Yes |
| HealthSpring Preferred GA (HMO) | H0439-003 | 5 | Yes | No | Yes |
| HealthSpring Preferred GA (HMO) | H0439-003 | 5 | Yes | No | Yes |
| HealthSpring Preferred Plus (HMO) | H0439-006 | 5 | Yes | No | Yes |
| HealthSpring Preferred Plus (HMO) | H4407-027 | 5 | Yes | No | Yes |
| HealthSpring Preferred Plus (HMO) | H4513-087 | 5 | Yes | No | Yes |
| HealthSpring Preferred Plus (HMO) | H4513-087 | 5 | Yes | No | Yes |
| HealthSpring Preferred Plus (HMO) | H4513-087 | 5 | Yes | No | Yes |
| HealthSpring Preferred Plus (HMO) | H4513-087 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H0439-016 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H0439-017 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H0439-018 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H0439-019 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H0439-021 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H0672-016 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H0672-017 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H4513-068 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H4513-068 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H4513-068 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H4513-073 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H4513-083 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H4513-083 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H4513-083 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H4513-083 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H4513-083 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H4513-083 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H4513-083 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H4513-086 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H4513-095 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H5410-026 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H7020-010 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H7020-010 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H7020-010 | 5 | Yes | No | Yes |
| HealthSpring Preferred Savings (HMO) | H9460-003 | 5 | Yes | No | Yes |
| HealthSpring Premier (HMO-POS) | H0439-024 | 5 | Yes | No | Yes |
| HealthSpring Premier (HMO-POS) | H4513-036 | 5 | Yes | No | Yes |
| HealthSpring Premier (HMO-POS) | H4513-084 | 5 | Yes | No | Yes |
| HealthSpring Premier (HMO-POS) | H4513-096 | 5 | Yes | No | Yes |
| HealthSpring Primary (HMO) | H4513-035 | 5 | Yes | No | Yes |
| HealthSpring Primary (HMO) | H4513-053 | 5 | Yes | No | Yes |
| HealthSpring TotalCare (HMO D-SNP) | H0439-002 | 5 | Yes | No | Yes |
Showing 100 of 171 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.
Retevmo 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.