Prior authorization required

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

Excellus Health Plan, INC. requires prior authorization for Lorbrena 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
lorlatinib 25 MG Oral Tablet [Lorbrena]2103175	16 / 16	16	0	16	Prior authorization required
lorlatinib 100 MG Oral Tablet [Lorbrena]2103179	16 / 16	16	0	16	Prior authorization required

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

Plan-by-plan detail — lorlatinib 25 MG Oral Tablet [Lorbrena]

Lorbrena has 2 products in the corpus; this table is for lorlatinib 25 MG Oral Tablet [Lorbrena], 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	5	Yes	No	Yes
Medicare Blue Choice Optimum (HMO-POS)	H3351-006	5	Yes	No	Yes
Medicare Blue Choice Prime (HMO)	H3351-023	5	Yes	No	Yes
Medicare BlueActive (PPO)	H3335-055	5	Yes	No	Yes
Medicare BlueBalanced (PPO)	H3335-062	5	Yes	No	Yes
Medicare BlueClassic (PPO)	H3335-038	5	Yes	No	Yes
Medicare BlueEnhanced (PPO)	H3335-015	5	Yes	No	Yes
Medicare BlueEssential (PPO)	H3335-053	5	Yes	No	Yes
Medicare BluePlus (PPO)	H3335-018	5	Yes	No	Yes
Medicare BlueVital (PPO)	H3335-061	5	Yes	No	Yes
Univera SeniorChoice Advanced (HMO-POS)	H3351-019	5	Yes	No	Yes
Univera SeniorChoice Basic (HMO)	H3351-017	5	Yes	No	Yes
Univera SeniorChoice Core (PPO)	H3335-060	5	Yes	No	Yes
Univera SeniorChoice Extra (HMO)	H3351-020	5	Yes	No	Yes
Univera SeniorChoice Secure (HMO-POS)	H3351-002	5	Yes	No	Yes
Univera SeniorChoice Value Plus (HMO-POS)	H3351-012	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.

Lorbrena at other payers

Or see Lorbrena 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.