No prior authorization
Does Excellus Health Plan, INC. require prior authorization for Nicotrol?
Excellus Health Plan, INC. does not require prior authorization for Nicotrol 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 |
|---|---|---|---|---|---|
| nicotine 0.5 MG/ACTUAT Metered Dose Nasal Spray [Nicotrol]1797888 | 16 / 16 | 0 | 0 | 0 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — nicotine 0.5 MG/ACTUAT Metered Dose Nasal Spray [Nicotrol]
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Medicare Blue Choice Core (HMO) | H3351-022 | 4 | No | No | No |
| Medicare Blue Choice Optimum (HMO-POS) | H3351-006 | 4 | No | No | No |
| Medicare Blue Choice Prime (HMO) | H3351-023 | 4 | No | No | No |
| Medicare BlueActive (PPO) | H3335-055 | 4 | No | No | No |
| Medicare BlueBalanced (PPO) | H3335-062 | 4 | No | No | No |
| Medicare BlueClassic (PPO) | H3335-038 | 4 | No | No | No |
| Medicare BlueEnhanced (PPO) | H3335-015 | 4 | No | No | No |
| Medicare BlueEssential (PPO) | H3335-053 | 4 | No | No | No |
| Medicare BluePlus (PPO) | H3335-018 | 4 | No | No | No |
| Medicare BlueVital (PPO) | H3335-061 | 4 | No | No | No |
| Univera SeniorChoice Advanced (HMO-POS) | H3351-019 | 4 | No | No | No |
| Univera SeniorChoice Basic (HMO) | H3351-017 | 4 | No | No | No |
| Univera SeniorChoice Core (PPO) | H3335-060 | 4 | No | No | No |
| Univera SeniorChoice Extra (HMO) | H3351-020 | 4 | No | No | No |
| Univera SeniorChoice Secure (HMO-POS) | H3351-002 | 4 | No | No | No |
| Univera SeniorChoice Value Plus (HMO-POS) | H3351-012 | 4 | No | 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.
Nicotrol 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.