Varies by plan

Does Freedom Health, INC. require prior authorization for Koselugo?

Prior authorization for Koselugo differs across Freedom Health, INC.'s Medicare Part D plans and product strengths — 3 of 4 Koselugo 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.

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	Status
selumetinib 10 MG Oral Capsule [Koselugo]2289424	24 / 24	24	Prior authorization required
selumetinib 25 MG Oral Capsule [Koselugo]2289428	24 / 24	24	Prior authorization required
selumetinib 5 MG Oral Granules [Koselugo]2723657	24 / 24	24	Prior authorization required
selumetinib 7.5 MG Oral Granules [Koselugo]2723661	0 / 24	0	Not on formulary

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

Plan-by-plan detail — selumetinib 10 MG Oral Capsule [Koselugo]

Koselugo has 4 products in the corpus; this table is for selumetinib 10 MG Oral Capsule [Koselugo], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
Freedom Medi-Medi Full (HMO D-SNP)	H5427-087	4	Yes	No	No
Freedom Medi-Medi Partial (HMO D-SNP)	H5427-078	4	Yes	No	No
Freedom Medicare Plan Rx (HMO)	H5427-059	4	Yes	No	No
Freedom Medicare Plan Rx (HMO)	H5427-060	4	Yes	No	No
Freedom M�ximo (HMO-POS)	H5427-112	4	Yes	No	No
Freedom M�ximo (HMO-POS)	H5427-113	4	Yes	No	No
Freedom Platinum Plan Rx (HMO)	H5427-088	4	Yes	No	No
Freedom Platinum Plan Rx (HMO)	H5427-089	4	Yes	No	No
Freedom Platinum Plan Rx (HMO)	H5427-091	4	Yes	No	No
Freedom Platinum Plan Rx (HMO)	H5427-093	4	Yes	No	No
Freedom Platinum Plan Rx (HMO)	H5427-094	4	Yes	No	No
Freedom Platinum Rewards Plan Rx (HMO)	H5427-096	4	Yes	No	No
Freedom Platinum Rewards Plan Rx (HMO)	H5427-102	4	Yes	No	No
Freedom Platinum Rewards Plan Rx (HMO)	H5427-103	4	Yes	No	No
Freedom Platinum Rewards Plan Rx (HMO)	H5427-105	4	Yes	No	No
Freedom Platinum Rewards Plan Rx (HMO)	H5427-106	4	Yes	No	No
Freedom Platinum Rewards Plan Rx (HMO)	H5427-107	4	Yes	No	No
Freedom VIP Care (HMO C-SNP)	H5427-070	4	Yes	No	No
Freedom VIP Rewards (HMO C-SNP)	H5427-099	4	Yes	No	No
Freedom VIP Rewards (HMO C-SNP)	H5427-108	4	Yes	No	No
Freedom VIP Savings (HMO C-SNP)	H5427-072	4	Yes	No	No
Freedom VIP Savings (HMO C-SNP)	H5427-082	4	Yes	No	No
Freedom VIP Savings COPD (HMO C-SNP)	H5427-077	4	Yes	No	No
Freedom VIP Savings COPD (HMO C-SNP)	H5427-083	4	Yes	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.

Koselugo at other payers

Or see Koselugo 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.