Prior authorization required
Does Cigna require prior authorization for Vizimpro?
Cigna requires prior authorization for Vizimpro 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 |
|---|---|---|---|---|---|
| dacomitinib 15 MG Oral Tablet [Vizimpro]2058922 | 171 / 171 | 171 | 0 | 171 | Prior authorization required |
| dacomitinib 30 MG Oral Tablet [Vizimpro]2058926 | 171 / 171 | 171 | 0 | 171 | Prior authorization required |
| dacomitinib 45 MG Oral Tablet [Vizimpro]2058932 | 171 / 171 | 171 | 0 | 171 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — dacomitinib 15 MG Oral Tablet [Vizimpro]
Vizimpro has 3 products in the corpus; this table is for dacomitinib 15 MG Oral Tablet [Vizimpro], 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.
Vizimpro 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.