Prior authorization required

Does Devoted Health require prior authorization for Doptelet?

Devoted Health requires prior authorization for Doptelet 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
avatrombopag 20 MG Oral Tablet [Doptelet]2045958	415 / 415	415	0	0	Prior authorization required
avatrombopag 10 MG Oral Granules [Doptelet]2721192	415 / 415	415	0	0	Prior authorization required

Product names come from RxNorm (U.S. National Library of Medicine).

Plan-by-plan detail — avatrombopag 20 MG Oral Tablet [Doptelet]

Doptelet has 2 products in the corpus; this table is for avatrombopag 20 MG Oral Tablet [Doptelet], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
DEVOTED C-SNP 003 NM (HMO C-SNP)	H9977-003	5	Yes	No	No
DEVOTED C-SNP 007 NM (HMO C-SNP)	H9977-007	5	Yes	No	No
DEVOTED C-SNP 011 AZ (HMO C-SNP)	H8173-011	5	Yes	No	No
DEVOTED C-SNP 023 AZ (HMO C-SNP)	H8173-023	5	Yes	No	No
DEVOTED C-SNP 027 TX (HMO C-SNP)	H7993-027	5	Yes	No	No
DEVOTED C-SNP 046 TX (HMO C-SNP)	H7993-046	5	Yes	No	No
DEVOTED C-SNP CHOICE 004 SC (PPO C-SNP)	H7028-004	5	Yes	No	No
DEVOTED C-SNP CHOICE 006 AR (PPO C-SNP)	H7397-006	5	Yes	No	No
DEVOTED C-SNP CHOICE 006 MS (PPO C-SNP)	H7355-006	5	Yes	No	No
DEVOTED C-SNP CHOICE 008 AL (PPO C-SNP)	H9888-008	5	Yes	No	No
DEVOTED C-SNP CHOICE 010 AL (PPO C-SNP)	H9888-010	5	Yes	No	No
DEVOTED C-SNP CHOICE PLUS 003 DE (PPO C-SNP)	H0413-003	5	Yes	No	No
DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP)	H4348-004	5	Yes	No	No
DEVOTED C-SNP CHOICE PLUS 004 KY (PPO C-SNP)	H5718-004	5	Yes	No	No
DEVOTED C-SNP CHOICE PLUS 006 NE (PPO C-SNP)	H9802-006	5	Yes	No	No
DEVOTED C-SNP CHOICE PLUS 006 SC (PPO C-SNP)	H7028-006	5	Yes	No	No
DEVOTED C-SNP CHOICE PLUS 006 WA (PPO C-SNP)	H8917-006	5	Yes	No	No
DEVOTED C-SNP CHOICE PLUS 007 UT (PPO C-SNP)	H4473-007	5	Yes	No	No
DEVOTED C-SNP CHOICE PLUS 008 OK (PPO C-SNP)	H2845-008	5	Yes	No	No
DEVOTED C-SNP CHOICE PLUS 010 AR (PPO C-SNP)	H7397-010	5	Yes	No	No
DEVOTED C-SNP CHOICE PLUS 010 MS (PPO C-SNP)	H7355-010	5	Yes	No	No
DEVOTED C-SNP CHOICE PLUS 012 AL (PPO C-SNP)	H9888-012	5	Yes	No	No
DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP)	H8320-012	5	Yes	No	No
DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP)	H7471-013	5	Yes	No	No
DEVOTED C-SNP CHOICE PLUS 014 LA (PPO C-SNP)	H7766-014	5	Yes	No	No
DEVOTED C-SNP CHOICE PLUS 015 AL (PPO C-SNP)	H9888-015	5	Yes	No	No
DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP)	H5453-016	5	Yes	No	No
DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP)	H9231-020	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP)	H4348-003	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 003 UT (PPO C-SNP)	H4473-003	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 005 KY (PPO C-SNP)	H5718-005	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP)	H7028-005	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP)	H8917-005	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP)	H5718-006	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 007 AR (PPO C-SNP)	H7397-007	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 007 KS (PPO C-SNP)	H4348-007	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 007 MS (PPO C-SNP)	H7355-007	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 009 AL (PPO C-SNP)	H9888-009	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 009 NE (PPO C-SNP)	H9802-009	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP)	H2845-009	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP)	H2845-010	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP)	H9888-011	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 011 IL (PPO C-SNP)	H8320-011	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP)	H7766-012	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP)	H8320-013	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO C-SNP)	H7766-013	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP)	H8320-014	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 014 IN (PPO C-SNP)	H7471-014	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP)	H5453-015	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 015 IN (PPO C-SNP)	H7471-015	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 016 IN (PPO C-SNP)	H7471-016	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP)	H9231-016	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP)	H5453-017	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 017 IN (PPO C-SNP)	H7471-017	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP)	H9231-017	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 018 GA (PPO C-SNP)	H5453-018	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 018 TN (PPO C-SNP)	H9231-018	5	Yes	No	No
DEVOTED C-SNP CHOICE PREMIUM 019 TN (PPO C-SNP)	H9231-019	5	Yes	No	No
DEVOTED C-SNP PLUS 003 HI (HMO C-SNP)	H5397-003	5	Yes	No	No
DEVOTED C-SNP PLUS 004 NM (HMO C-SNP)	H9977-004	5	Yes	No	No
DEVOTED C-SNP PLUS 004 VA (HMO C-SNP)	H6994-004	5	Yes	No	No
DEVOTED C-SNP PLUS 006 IL (HMO C-SNP)	H7151-006	5	Yes	No	No
DEVOTED C-SNP PLUS 009 OR (HMO C-SNP)	H2923-009	5	Yes	No	No
DEVOTED C-SNP PLUS 013 CO (HMO C-SNP)	H7147-013	5	Yes	No	No
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)	H5299-015	5	Yes	No	No
DEVOTED C-SNP PLUS 016 MO (HMO C-SNP)	H2041-016	5	Yes	No	No
DEVOTED C-SNP PLUS 016 OH (HMO C-SNP)	H2697-016	5	Yes	No	No
DEVOTED C-SNP PLUS 021 PA (HMO C-SNP)	H6852-021	5	Yes	No	No
DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP)	H8173-022	5	Yes	No	No
DEVOTED C-SNP PLUS 022 PA (HMO C-SNP)	H6852-022	5	Yes	No	No
DEVOTED C-SNP PLUS 024 TX (HMO C-SNP)	H7993-024	5	Yes	No	No
DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP)	H8173-025	5	Yes	No	No
DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP)	H8173-027	5	Yes	No	No
DEVOTED C-SNP PLUS 029 TX (HMO C-SNP)	H7993-029	5	Yes	No	No
DEVOTED C-SNP PLUS 031 TX (HMO C-SNP)	H7993-031	5	Yes	No	No
DEVOTED C-SNP PLUS 033 TX (HMO C-SNP)	H7993-033	5	Yes	No	No
DEVOTED C-SNP PLUS 036 IA (HMO C-SNP)	H7993-036	5	Yes	No	No
DEVOTED C-SNP PLUS 084 FL (HMO C-SNP)	H1290-084	5	Yes	No	No
DEVOTED C-SNP PLUS 085 FL (HMO C-SNP)	H1290-085	5	Yes	No	No
DEVOTED C-SNP PLUS 086 FL (HMO C-SNP)	H1290-086	5	Yes	No	No
DEVOTED C-SNP PLUS 087 FL (HMO C-SNP)	H1290-087	5	Yes	No	No
DEVOTED C-SNP PLUS 088 FL (HMO C-SNP)	H1290-088	5	Yes	No	No
DEVOTED C-SNP PLUS 089 FL (HMO C-SNP)	H1290-089	5	Yes	No	No
DEVOTED C-SNP PLUS 090 FL (HMO C-SNP)	H1290-090	5	Yes	No	No
DEVOTED C-SNP PLUS 091 FL (HMO C-SNP)	H1290-091	5	Yes	No	No
DEVOTED C-SNP PREMIUM 003 VA (HMO C-SNP)	H6994-003	5	Yes	No	No
DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP)	H7151-005	5	Yes	No	No
DEVOTED C-SNP PREMIUM 009 CO (HMO C-SNP)	H7147-009	5	Yes	No	No
DEVOTED C-SNP PREMIUM 010 CO (HMO C-SNP)	H7147-010	5	Yes	No	No
DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP)	H6994-010	5	Yes	No	No
DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP)	H7147-011	5	Yes	No	No
DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP)	H2041-012	5	Yes	No	No
DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP)	H2041-013	5	Yes	No	No
DEVOTED C-SNP PREMIUM 013 VA (HMO C-SNP)	H6994-013	5	Yes	No	No
DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP)	H8173-014	5	Yes	No	No
DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP)	H2041-014	5	Yes	No	No
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)	H5299-014	5	Yes	No	No
DEVOTED C-SNP PREMIUM 015 MO (HMO C-SNP)	H2041-015	5	Yes	No	No
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)	H5299-016	5	Yes	No	No
DEVOTED C-SNP PREMIUM 016 PA (HMO C-SNP)	H6852-016	5	Yes	No	No

Showing 100 of 415 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.

Doptelet at other payers

Or see Doptelet across every payer at once.

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.