No prior authorization
Does Freedom Health, INC. require prior authorization for Matulane?
Freedom Health, INC. does not require prior authorization for Matulane 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 |
|---|---|---|---|---|---|
| procarbazine 50 MG Oral Capsule [Matulane]207588 | 24 / 24 | 0 | 0 | 0 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — procarbazine 50 MG Oral Capsule [Matulane]
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Freedom Medi-Medi Full (HMO D-SNP) | H5427-087 | 4 | No | No | No |
| Freedom Medi-Medi Partial (HMO D-SNP) | H5427-078 | 4 | No | No | No |
| Freedom Medicare Plan Rx (HMO) | H5427-059 | 4 | No | No | No |
| Freedom Medicare Plan Rx (HMO) | H5427-060 | 4 | No | No | No |
| Freedom M�ximo (HMO-POS) | H5427-112 | 4 | No | No | No |
| Freedom M�ximo (HMO-POS) | H5427-113 | 4 | No | No | No |
| Freedom Platinum Plan Rx (HMO) | H5427-088 | 4 | No | No | No |
| Freedom Platinum Plan Rx (HMO) | H5427-089 | 4 | No | No | No |
| Freedom Platinum Plan Rx (HMO) | H5427-091 | 4 | No | No | No |
| Freedom Platinum Plan Rx (HMO) | H5427-093 | 4 | No | No | No |
| Freedom Platinum Plan Rx (HMO) | H5427-094 | 4 | No | No | No |
| Freedom Platinum Rewards Plan Rx (HMO) | H5427-096 | 4 | No | No | No |
| Freedom Platinum Rewards Plan Rx (HMO) | H5427-102 | 4 | No | No | No |
| Freedom Platinum Rewards Plan Rx (HMO) | H5427-103 | 4 | No | No | No |
| Freedom Platinum Rewards Plan Rx (HMO) | H5427-105 | 4 | No | No | No |
| Freedom Platinum Rewards Plan Rx (HMO) | H5427-106 | 4 | No | No | No |
| Freedom Platinum Rewards Plan Rx (HMO) | H5427-107 | 4 | No | No | No |
| Freedom VIP Care (HMO C-SNP) | H5427-070 | 4 | No | No | No |
| Freedom VIP Rewards (HMO C-SNP) | H5427-099 | 4 | No | No | No |
| Freedom VIP Rewards (HMO C-SNP) | H5427-108 | 4 | No | No | No |
| Freedom VIP Savings (HMO C-SNP) | H5427-072 | 4 | No | No | No |
| Freedom VIP Savings (HMO C-SNP) | H5427-082 | 4 | No | No | No |
| Freedom VIP Savings COPD (HMO C-SNP) | H5427-077 | 4 | No | No | No |
| Freedom VIP Savings COPD (HMO C-SNP) | H5427-083 | 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.
Matulane 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.