Benefily
No prior authorization

Does Excellus Health Plan, INC. require prior authorization for Humalog Mix?

Excellus Health Plan, INC. does not require prior authorization for Humalog Mix 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 productPlans coveringRequire prior authStep therapyQty limitStatus
insulin lispro 25 UNT/ML / insulin lispro protamine, human 75 UNT/ML Injectable Suspension [Humalog Mix]75238816 / 16000No prior authorization
3 ML insulin lispro 50 UNT/ML / insulin lispro protamine, human 50 UNT/ML Pen Injector [Humalog Mix]84721316 / 16000No prior authorization
3 ML insulin lispro 25 UNT/ML / insulin lispro protamine, human 75 UNT/ML Pen Injector [Humalog Mix]84725416 / 16000No prior authorization

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

Plan-by-plan detail — insulin lispro 25 UNT/ML / insulin lispro protamine, human 75 UNT/ML Injectable Suspension [Humalog Mix]

Humalog Mix has 3 products in the corpus; this table is for insulin lispro 25 UNT/ML / insulin lispro protamine, human 75 UNT/ML Injectable Suspension [Humalog Mix], the one carried on the most plans. The product table above covers every strength.

PlanContractTierPrior authStep therapyQty limit
Medicare Blue Choice Core (HMO)H3351-0223NoNoNo
Medicare Blue Choice Optimum (HMO-POS)H3351-0063NoNoNo
Medicare Blue Choice Prime (HMO)H3351-0233NoNoNo
Medicare BlueActive (PPO)H3335-0553NoNoNo
Medicare BlueBalanced (PPO)H3335-0623NoNoNo
Medicare BlueClassic (PPO)H3335-0383NoNoNo
Medicare BlueEnhanced (PPO)H3335-0153NoNoNo
Medicare BlueEssential (PPO)H3335-0533NoNoNo
Medicare BluePlus (PPO)H3335-0183NoNoNo
Medicare BlueVital (PPO)H3335-0613NoNoNo
Univera SeniorChoice Advanced (HMO-POS)H3351-0193NoNoNo
Univera SeniorChoice Basic (HMO)H3351-0173NoNoNo
Univera SeniorChoice Core (PPO)H3335-0603NoNoNo
Univera SeniorChoice Extra (HMO)H3351-0203NoNoNo
Univera SeniorChoice Secure (HMO-POS)H3351-0023NoNoNo
Univera SeniorChoice Value Plus (HMO-POS)H3351-0123NoNoNo
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.

Humalog Mix at other payers

Or see Humalog Mix 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.