Does Excellus Health Plan, INC. require prior authorization for Gvoke?
Excellus Health Plan, INC. does not require prior authorization for Gvoke 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 |
|---|---|---|---|---|---|
| 0.1 ML glucagon 5 MG/ML Auto-Injector [Gvoke]2199304 | 16 / 16 | 0 | 0 | 16 | No prior authorization |
| 0.2 ML glucagon 5 MG/ML Auto-Injector [Gvoke]2199308 | 16 / 16 | 0 | 0 | 16 | No prior authorization |
| 0.2 ML glucagon 5 MG/ML Prefilled Syringe [Gvoke]2199316 | 16 / 16 | 0 | 0 | 16 | No prior authorization |
| 0.2 ML glucagon 5 MG/ML Injection [Gvoke]2587361 | 16 / 16 | 0 | 0 | 16 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — 0.1 ML glucagon 5 MG/ML Auto-Injector [Gvoke]
Gvoke has 4 products in the corpus; this table is for 0.1 ML glucagon 5 MG/ML Auto-Injector [Gvoke], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Medicare Blue Choice Core (HMO) | H3351-022 | 3 | No | No | Yes |
| Medicare Blue Choice Optimum (HMO-POS) | H3351-006 | 3 | No | No | Yes |
| Medicare Blue Choice Prime (HMO) | H3351-023 | 3 | No | No | Yes |
| Medicare BlueActive (PPO) | H3335-055 | 3 | No | No | Yes |
| Medicare BlueBalanced (PPO) | H3335-062 | 3 | No | No | Yes |
| Medicare BlueClassic (PPO) | H3335-038 | 3 | No | No | Yes |
| Medicare BlueEnhanced (PPO) | H3335-015 | 3 | No | No | Yes |
| Medicare BlueEssential (PPO) | H3335-053 | 3 | No | No | Yes |
| Medicare BluePlus (PPO) | H3335-018 | 3 | No | No | Yes |
| Medicare BlueVital (PPO) | H3335-061 | 3 | No | No | Yes |
| Univera SeniorChoice Advanced (HMO-POS) | H3351-019 | 3 | No | No | Yes |
| Univera SeniorChoice Basic (HMO) | H3351-017 | 3 | No | No | Yes |
| Univera SeniorChoice Core (PPO) | H3335-060 | 3 | No | No | Yes |
| Univera SeniorChoice Extra (HMO) | H3351-020 | 3 | No | No | Yes |
| Univera SeniorChoice Secure (HMO-POS) | H3351-002 | 3 | No | No | Yes |
| Univera SeniorChoice Value Plus (HMO-POS) | H3351-012 | 3 | No | No | Yes |
- 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.
Gvoke at other payers
Or see Gvoke 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.