Does Florida Blue Medicare, INC. require prior authorization for Fetzima?
Prior authorization for Fetzima differs across Florida Blue Medicare, INC.'s Medicare Part D plans and product strengths — 3 of 4 Fetzima 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 15 covering plans require it. Check the specific plan the member is enrolled in — the plan name and contract number are on their insurance card.
- This drug does not appear on any of this payer's Medicare Part D formularies. That means it is NOT COVERED under those plans — which is a different and generally worse outcome than requiring prior authorization. An exception or formulary-exception request may still be possible.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| 24 HR levomilnacipran 120 MG Extended Release Oral Capsule [Fetzima]1433223 | 15 / 15 | 2 | 0 | 15 | Varies by plan |
| 24 HR levomilnacipran 20 MG Extended Release Oral Capsule [Fetzima]1433229 | 15 / 15 | 2 | 0 | 15 | Varies by plan |
| 24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima]1433235 | 15 / 15 | 2 | 0 | 15 | Varies by plan |
| 24 HR levomilnacipran 80 MG Extended Release Oral Capsule [Fetzima]1433241 | 0 / 15 | 0 | 0 | 0 | Not on formulary |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — 24 HR levomilnacipran 120 MG Extended Release Oral Capsule [Fetzima]
Fetzima has 4 products in the corpus; this table is for 24 HR levomilnacipran 120 MG Extended Release Oral Capsule [Fetzima], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| BlueMedicare Classic (HMO) | H1035-017 | 4 | No | No | Yes |
| BlueMedicare Classic (HMO) | H1035-019 | 4 | No | No | Yes |
| BlueMedicare Classic (HMO) | H1035-020 | 4 | No | No | Yes |
| BlueMedicare Classic (HMO) | H1035-021 | 4 | No | No | Yes |
| BlueMedicare Preferred (HMO) | H1035-052 | 4 | No | No | Yes |
| BlueMedicare Premier (HMO) | H1035-022 | 4 | No | No | Yes |
| BlueMedicare Premier (HMO) | H1035-025 | 4 | No | No | Yes |
| BlueMedicare Premier (HMO) | H1035-026 | 4 | No | No | Yes |
| BlueMedicare Premier (HMO) | H1035-033 | 4 | No | No | Yes |
| BlueMedicare Premier (HMO) | H1035-034 | 4 | No | No | Yes |
| BlueMedicare Premier (HMO) | H1035-043 | 4 | No | No | Yes |
| BlueMedicare Premier (HMO) | H1035-045 | 4 | No | No | Yes |
| BlueMedicare Premier (HMO) | H1035-048 | 4 | No | No | Yes |
| FHCP Medicare Classic (HMO) | H1035-040 | 4 | Yes | No | Yes |
| FHCP Medicare Rx Plus (HMO-POS) | H1035-002 | 4 | Yes | 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.
Fetzima 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.