Does Geisinger Indemnity Insurance Company require prior authorization for Koselugo?
Geisinger Indemnity Insurance Company requires prior authorization for Koselugo 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 |
|---|---|---|---|---|---|
| selumetinib 10 MG Oral Capsule [Koselugo]2289424 | 3 / 3 | 3 | 0 | 3 | Prior authorization required |
| selumetinib 25 MG Oral Capsule [Koselugo]2289428 | 3 / 3 | 3 | 0 | 3 | Prior authorization required |
| selumetinib 5 MG Oral Granules [Koselugo]2723657 | 3 / 3 | 3 | 0 | 3 | Prior authorization required |
| selumetinib 7.5 MG Oral Granules [Koselugo]2723661 | 3 / 3 | 3 | 0 | 3 | Prior authorization required |
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 |
|---|---|---|---|---|---|
| Geisinger Gold Preferred Advantage Rx (PPO) | H3924-059 | 5 | Yes | No | Yes |
| Geisinger Gold Preferred Advantage Rx (PPO) | H3924-059 | 5 | Yes | No | Yes |
| Geisinger Gold Preferred Complete Rx (PPO) | H3924-065 | 5 | Yes | No | Yes |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
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Koselugo 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.