Prior authorization required

Does Freedom Health, INC. require prior authorization for Lenvima 4?

Freedom Health, INC. requires prior authorization for Lenvima 4 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
{30 (lenvatinib 4 MG Oral Capsule [Lenvima]) } Pack [Lenvima 4]2054157	24 / 24	24	0	24	Prior authorization required

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

Plan-by-plan detail — {30 (lenvatinib 4 MG Oral Capsule [Lenvima]) } Pack [Lenvima 4]

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

Lenvima 4 at other payers

Or see Lenvima 4 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.