Benefily
Prior authorization required

Does Hcsc Insurance Services Company require prior authorization for Matulane?

Hcsc Insurance Services Company requires prior authorization for Matulane 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 productPlans coveringRequire prior authStep therapyQty limitStatus
procarbazine 50 MG Oral Capsule [Matulane]20758818 / 181800Prior authorization required

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

Plan-by-plan detail — procarbazine 50 MG Oral Capsule [Matulane]

PlanContractTierPrior authStep therapyQty limit
Blue Cross Medicare Advantage Access (PPO)H1666-0215YesNoNo
Blue Cross Medicare Advantage Balance (PPO)H1666-0195YesNoNo
Blue Cross Medicare Advantage Balance (PPO)H1666-0235YesNoNo
Blue Cross Medicare Advantage Choice Plus (PPO)H1666-0065YesNoNo
Blue Cross Medicare Advantage Choice Plus (PPO)H1666-0085YesNoNo
Blue Cross Medicare Advantage Choice Premier (PPO)H1666-0035YesNoNo
Blue Cross Medicare Advantage Choice Premier (PPO)H1666-0125YesNoNo
Blue Cross Medicare Advantage Dental Premier (PPO)H1666-0165YesNoNo
Blue Cross Medicare Advantage Dental Value (HMO)H9706-0075YesNoNo
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP)H9706-0021YesNoNo
Blue Cross Medicare Advantage Health Choice (PPO)H1666-0145YesNoNo
Blue Cross Medicare Advantage Optimum (PPO)H1666-0205YesNoNo
Blue Cross Medicare Advantage Optimum (PPO)H1666-0225YesNoNo
Blue Cross Medicare Advantage Optimum (PPO)H1666-0245YesNoNo
Blue Cross Medicare Advantage Saver (HMO)H9706-0085YesNoNo
Blue Cross Medicare Advantage Secure (HMO)H9706-0055YesNoNo
Blue Cross Medicare Advantage Value (HMO)H9706-0015YesNoNo
Blue Cross Medicare Advantage Value (HMO)H9706-0095YesNoNo
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

Or see Matulane 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.