Varies by plan
Does Elevance Health (Anthem) require prior authorization for Pegasys?
Prior authorization for Pegasys differs across Elevance Health (Anthem)'s Medicare Part D plans and product strengths — 2 of 2 Pegasys 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.
- Prior authorization requirements differ across this payer's plans: 2 of 67 covering plans require it. Check the specific plan the member is enrolled in — the plan name and contract number are on their insurance card.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| 1 ML peginterferon alfa-2a 0.18 MG/ML Injection [Pegasys]352297 | 67 / 67 | 2 | 0 | 0 | Varies by plan |
| 0.5 ML peginterferon alfa-2a 0.36 MG/ML Prefilled Syringe [Pegasys]731328 | 67 / 67 | 2 | 0 | 0 | Varies by plan |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — 1 ML peginterferon alfa-2a 0.18 MG/ML Injection [Pegasys]
Pegasys has 2 products in the corpus; this table is for 1 ML peginterferon alfa-2a 0.18 MG/ML Injection [Pegasys], 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 | No | No | No |
| Anthem Chronic Care (HMO-POS C-SNP) | H3447-056 | 5 | No | No | No |
| Anthem Dual Advantage (HMO D-SNP) | H0629-002 | 5 | No | No | No |
| Anthem Dual Advantage (HMO D-SNP) | H4694-002 | 5 | No | No | No |
| Anthem Dual Advantage (HMO D-SNP) | H5854-020 | 5 | No | No | No |
| Anthem Dual Advantage (PPO D-SNP) | H2441-001 | 5 | No | No | No |
| Anthem Dual Advantage (PPO D-SNP) | H2836-007 | 5 | No | No | No |
| Anthem Extra Help (HMO-POS) | H3447-024 | 5 | No | No | No |
| Anthem Full Dual Advantage (HMO D-SNP) | H0629-001 | 5 | No | No | No |
| Anthem Full Dual Advantage (HMO D-SNP) | H3447-018 | 5 | No | No | No |
| Anthem Full Dual Advantage (HMO D-SNP) | H4694-004 | 5 | No | No | No |
| Anthem Full Dual Advantage (PPO D-SNP) | H2836-006 | 5 | No | No | No |
| Anthem Full Dual Advantage 2 (HMO D-SNP) | H3447-053 | 5 | No | No | No |
| Anthem Full Dual Advantage 2 (HMO D-SNP) | H4694-001 | 5 | No | No | No |
| Anthem Full Dual Advantage Select (HMO D-SNP) | H5854-013 | 5 | No | No | No |
| Anthem Full Dual Advantage Support (HMO D-SNP) | H4694-003 | 5 | No | No | No |
| Anthem HealthPlus Full Dual Advantage (HMO D-SNP) | H8432-042 | 5 | No | No | No |
| Anthem HealthPlus Full Dual Advantage LTSS (HMO D-SNP) | H8432-041 | 5 | No | No | No |
| Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) | H6988-004 | 5 | No | No | No |
| Anthem I PathWays Dual Care Advantage (HMO D-SNP) | H0629-003 | 5 | No | No | No |
| Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) | H0629-004 | 5 | No | No | No |
| Anthem Kidney Care (HMO-POS C-SNP) | H3447-033 | 5 | No | No | No |
| Anthem Kidney Care (HMO-POS C-SNP) | H5854-012 | 5 | No | No | No |
| Anthem Kidney Care (PPO C-SNP) | H8552-028 | 5 | No | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-013 | 5 | No | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-038 | 5 | No | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-038 | 5 | No | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-042 | 5 | No | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-042 | 5 | No | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-042 | 5 | No | No | No |
| Anthem Medicare Advantage (HMO-POS) | H3447-042 | 5 | No | No | No |
| Anthem Medicare Advantage (HMO-POS) | H8432-040 | 5 | No | No | No |
| Anthem Medicare Advantage (HMO) | H5854-019 | 5 | No | No | No |
| Anthem Medicare Advantage (HMO) | H5854-019 | 5 | No | No | No |
| Anthem Medicare Advantage (HMO) | H8432-009 | 5 | No | No | No |
| Anthem Medicare Advantage (HMO) | H8432-010 | 5 | No | No | No |
| Anthem Medicare Advantage (HMO) | H8432-011 | 5 | No | No | No |
| Anthem Medicare Advantage (PPO) | H4036-026 | 5 | No | No | No |
| Anthem Medicare Advantage (PPO) | H4036-036 | 5 | No | No | No |
| Anthem Medicare Advantage (PPO) | H4909-014 | 5 | No | No | No |
| Anthem Medicare Advantage (Regional PPO) | R5941-014 | 5 | No | No | No |
| Anthem Medicare Advantage (Regional PPO) | R5941-016 | 5 | No | No | No |
| Anthem Medicare Advantage 2 (HMO-POS) | H3447-025 | 5 | No | No | No |
| Anthem Medicare Advantage 2 (HMO-POS) | H6988-006 | 5 | No | No | No |
| Anthem Medicare Advantage 2 (HMO-POS) | H6988-009 | 5 | No | No | No |
| Anthem Medicare Advantage 2 (HMO-POS) | H6988-010 | 5 | No | No | No |
| Anthem Medicare Advantage 2 (HMO-POS) | H7220-004 | 5 | No | No | No |
| Anthem Medicare Advantage 2 (HMO-POS) | H8432-016 | 5 | No | No | No |
| Anthem Medicare Advantage 2 (PPO) | H1607-015 | 5 | No | No | No |
| Anthem Medicare Advantage 2 (PPO) | H4036-030 | 5 | No | No | No |
| Anthem Medicare Advantage 2 (PPO) | H4909-026 | 5 | No | No | No |
| Anthem Medicare Advantage 3 (HMO-POS) | H3447-049 | 5 | No | No | No |
| Anthem Medicare Advantage 3 (HMO-POS) | H3447-050 | 5 | No | No | No |
| Anthem Medicare Advantage 3 (HMO-POS) | H3447-051 | 5 | No | No | No |
| Anthem Medicare Advantage 3 (HMO-POS) | H3447-052 | 5 | No | No | No |
| Anthem Medicare Advantage 3 (HMO-POS) | H6988-007 | 5 | No | No | No |
| Anthem Medicare Advantage 3 (HMO) | H7220-009 | 5 | No | No | No |
| Anthem Medicare Advantage 3 (HMO) | H7220-009 | 5 | No | No | No |
| Anthem Medicare Advantage 3 (PPO) | H1607-012 | 5 | No | No | No |
| Anthem Medicare Advantage 3 (PPO) | H4036-008 | 5 | No | No | No |
| Anthem Medicare Advantage 3 (PPO) | H4036-025 | 5 | No | No | No |
| Anthem Medicare Advantage 3 (PPO) | H4036-034 | 5 | No | No | No |
| Anthem Medicare Advantage 4 (HMO-POS) | H3447-039 | 5 | No | No | No |
| Anthem Medicare Advantage 4 (HMO) | H7220-010 | 5 | No | No | No |
| Anthem Medicare Advantage 4 (PPO) | H4036-017 | 5 | No | No | No |
| Blue MedicareRx Premier (PDP) | S2893-003 | 5 | Yes | No | No |
| Blue MedicareRx Value Plus (PDP) | S2893-001 | 5 | Yes | No | No |
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.
Pegasys 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.