Prior authorization required
Does Elevance Health (Anthem) require prior authorization for Lonsurf?
Elevance Health (Anthem) requires prior authorization for Lonsurf 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 |
|---|---|---|---|---|---|
| tipiracil 6.14 MG / trifluridine 15 MG Oral Tablet [Lonsurf]1670322 | 67 / 67 | 67 | 0 | 2 | Prior authorization required |
| tipiracil 8.19 MG / trifluridine 20 MG Oral Tablet [Lonsurf]1670324 | 67 / 67 | 67 | 0 | 2 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — tipiracil 6.14 MG / trifluridine 15 MG Oral Tablet [Lonsurf]
Lonsurf has 2 products in the corpus; this table is for tipiracil 6.14 MG / trifluridine 15 MG Oral Tablet [Lonsurf], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Anthem Chronic Care (HMO-POS C-SNP) | H3447-037 | 5 | Yes | No | No |
| Anthem Chronic Care (HMO-POS C-SNP) | H3447-056 | 5 | Yes | No | No |
| Anthem Dual Advantage (HMO D-SNP) | H0629-002 | 5 | Yes | No | No |
| Anthem Dual Advantage (HMO D-SNP) | H4694-002 | 5 | Yes | No | No |
| Anthem Dual Advantage (HMO D-SNP) | H5854-020 | 5 | Yes | No | No |
| Anthem Dual Advantage (PPO D-SNP) | H2441-001 | 5 | Yes | No | No |
| Anthem Dual Advantage (PPO D-SNP) | H2836-007 | 5 | Yes | No | No |
| Anthem Extra Help (HMO-POS) | H3447-024 | 5 | Yes | No | No |
| Anthem Full Dual Advantage (HMO D-SNP) | H0629-001 | 5 | Yes | No | No |
| Anthem Full Dual Advantage (HMO D-SNP) | H3447-018 | 5 | Yes | No | No |
| Anthem Full Dual Advantage (HMO D-SNP) | H4694-004 | 5 | Yes | No | No |
| Anthem Full Dual Advantage (PPO D-SNP) | H2836-006 | 5 | Yes | No | No |
| Anthem Full Dual Advantage 2 (HMO D-SNP) | H3447-053 | 5 | Yes | No | No |
| Anthem Full Dual Advantage 2 (HMO D-SNP) | H4694-001 | 5 | Yes | No | No |
| Anthem Full Dual Advantage Select (HMO D-SNP) | H5854-013 | 5 | Yes | No | No |
| Anthem Full Dual Advantage Support (HMO D-SNP) | H4694-003 | 5 | Yes | No | No |
| Anthem HealthPlus Full Dual Advantage (HMO D-SNP) | H8432-042 | 5 | Yes | No | No |
| Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) | H8432-041 | 5 | Yes | No | No |
| Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) | H6988-004 | 5 | Yes | No | No |
| Anthem I PathWays Dual Care Advantage (HMO D-SNP) | H0629-003 | 5 | Yes | No | No |
| Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) | H0629-004 | 5 | Yes | No | No |
| Anthem Kidney Care (HMO-POS C-SNP) | H3447-033 | 5 | Yes | No | No |
| Anthem Kidney Care (HMO-POS C-SNP) | H5854-012 | 5 | Yes | No | No |
| Anthem Kidney Care (PPO C-SNP) | H8552-028 | 5 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-013 | 5 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-038 | 5 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-038 | 5 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-042 | 5 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-042 | 5 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-042 | 5 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-042 | 5 | Yes | No | No |
| Anthem Medicare Advantage (HMO-POS) | H8432-040 | 5 | Yes | No | No |
| Anthem Medicare Advantage (HMO) | H5854-019 | 5 | Yes | No | No |
| Anthem Medicare Advantage (HMO) | H5854-019 | 5 | Yes | No | No |
| Anthem Medicare Advantage (HMO) | H8432-009 | 5 | Yes | No | No |
| Anthem Medicare Advantage (HMO) | H8432-010 | 5 | Yes | No | No |
| Anthem Medicare Advantage (HMO) | H8432-011 | 5 | Yes | No | No |
| Anthem Medicare Advantage (PPO) | H4036-026 | 5 | Yes | No | No |
| Anthem Medicare Advantage (PPO) | H4036-036 | 5 | Yes | No | No |
| Anthem Medicare Advantage (PPO) | H4909-014 | 5 | Yes | No | No |
| Anthem Medicare Advantage (Regional PPO) | R5941-014 | 5 | Yes | No | No |
| Anthem Medicare Advantage (Regional PPO) | R5941-016 | 5 | Yes | No | No |
| Anthem Medicare Advantage 2 (HMO-POS) | H3447-025 | 5 | Yes | No | No |
| Anthem Medicare Advantage 2 (HMO-POS) | H6988-006 | 5 | Yes | No | No |
| Anthem Medicare Advantage 2 (HMO-POS) | H6988-009 | 5 | Yes | No | No |
| Anthem Medicare Advantage 2 (HMO-POS) | H6988-010 | 5 | Yes | No | No |
| Anthem Medicare Advantage 2 (HMO-POS) | H7220-004 | 5 | Yes | No | No |
| Anthem Medicare Advantage 2 (HMO-POS) | H8432-016 | 5 | Yes | No | No |
| Anthem Medicare Advantage 2 (PPO) | H1607-015 | 5 | Yes | No | No |
| Anthem Medicare Advantage 2 (PPO) | H4036-030 | 5 | Yes | No | No |
| Anthem Medicare Advantage 2 (PPO) | H4909-026 | 5 | Yes | No | No |
| Anthem Medicare Advantage 3 (HMO-POS) | H3447-049 | 5 | Yes | No | No |
| Anthem Medicare Advantage 3 (HMO-POS) | H3447-050 | 5 | Yes | No | No |
| Anthem Medicare Advantage 3 (HMO-POS) | H3447-051 | 5 | Yes | No | No |
| Anthem Medicare Advantage 3 (HMO-POS) | H3447-052 | 5 | Yes | No | No |
| Anthem Medicare Advantage 3 (HMO-POS) | H6988-007 | 5 | Yes | No | No |
| Anthem Medicare Advantage 3 (HMO) | H7220-009 | 5 | Yes | No | No |
| Anthem Medicare Advantage 3 (HMO) | H7220-009 | 5 | Yes | No | No |
| Anthem Medicare Advantage 3 (PPO) | H1607-012 | 5 | Yes | No | No |
| Anthem Medicare Advantage 3 (PPO) | H4036-008 | 5 | Yes | No | No |
| Anthem Medicare Advantage 3 (PPO) | H4036-025 | 5 | Yes | No | No |
| Anthem Medicare Advantage 3 (PPO) | H4036-034 | 5 | Yes | No | No |
| Anthem Medicare Advantage 4 (HMO-POS) | H3447-039 | 5 | Yes | No | No |
| Anthem Medicare Advantage 4 (HMO) | H7220-010 | 5 | Yes | No | No |
| Anthem Medicare Advantage 4 (PPO) | H4036-017 | 5 | Yes | No | No |
| Blue MedicareRx Premier (PDP) | S2893-003 | 5 | Yes | No | Yes |
| Blue MedicareRx Value Plus (PDP) | S2893-001 | 5 | Yes | No | Yes |
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.
Lonsurf 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.