Does Clover Health require prior authorization for Gleostine?
Clover Health does not require prior authorization for Gleostine 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 |
|---|---|---|---|---|---|
| lomustine 10 MG Oral Capsule [Gleostine]1545776 | 13 / 13 | 0 | 0 | 0 | No prior authorization |
| lomustine 100 MG Oral Capsule [Gleostine]1545778 | 13 / 13 | 0 | 0 | 0 | No prior authorization |
| lomustine 40 MG Oral Capsule [Gleostine]1545780 | 13 / 13 | 0 | 0 | 0 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — lomustine 10 MG Oral Capsule [Gleostine]
Gleostine has 3 products in the corpus; this table is for lomustine 10 MG Oral Capsule [Gleostine], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Clover Health Choice (PPO) | H5141-004 | 4 | No | No | No |
| Clover Health Choice (PPO) | H5141-025 | 4 | No | No | No |
| Clover Health Choice (PPO) | H5141-032 | 4 | No | No | No |
| Clover Health Choice (PPO) | H5141-038 | 4 | No | No | No |
| Clover Health Choice Giveback (PPO) | H5141-054 | 4 | No | No | No |
| Clover Health Choice Value (PPO) | H5141-007 | 4 | No | No | No |
| Clover Health Choice Value (PPO) | H5141-042 | 4 | No | No | No |
| Clover Health Classic (HMO) | H8010-002 | 4 | No | No | No |
| Clover Health LiveHealthy (PPO) | H5141-026 | 4 | No | No | No |
| Clover Health LiveHealthy (PPO) | H5141-036 | 4 | No | No | No |
| Clover Health LiveHealthy Giveback (PPO) | H5141-063 | 4 | No | No | No |
| Clover Health LiveHealthy Value (PPO) | H5141-045 | 4 | No | No | No |
| Clover Health Value (HMO) | H8010-003 | 4 | No | No | No |
- 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.
Gleostine 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.