Does Gateway Health Plan, INC. require prior authorization for Xalkori?
Prior authorization for Xalkori differs across Gateway Health Plan, INC.'s Medicare Part D plans and product strengths — 3 of 5 Xalkori 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 | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| crizotinib 200 MG Oral Capsule [Xalkori]1148502 | 4 / 4 | 4 | 0 | 4 | Prior authorization required |
| crizotinib 250 MG Oral Capsule [Xalkori]1148506 | 4 / 4 | 4 | 0 | 4 | Prior authorization required |
| crizotinib 150 MG Oral Pellet [Xalkori]2670170 | 4 / 4 | 4 | 0 | 4 | Prior authorization required |
| crizotinib 20 MG Oral Pellet [Xalkori]2670174 | 0 / 4 | 0 | 0 | 0 | Not on formulary |
| crizotinib 50 MG Oral Pellet [Xalkori]2670178 | 0 / 4 | 0 | 0 | 0 | Not on formulary |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — crizotinib 200 MG Oral Capsule [Xalkori]
Xalkori has 5 products in the corpus; this table is for crizotinib 200 MG Oral Capsule [Xalkori], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | H5932-001 | 1 | Yes | No | Yes |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | H5932-012 | 1 | Yes | No | Yes |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | H5932-009 | 1 | Yes | No | Yes |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | H5932-013 | 1 | Yes | No | Yes |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
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Xalkori 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.