Does Hcsc Insurance Services Company require prior authorization for Spritam?
Hcsc Insurance Services Company does not require prior authorization for Spritam 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 |
|---|---|---|---|---|---|
| levetiracetam 250 MG Tablet for Oral Suspension [Spritam]1736047 | 18 / 18 | 0 | 0 | 0 | No prior authorization |
| levetiracetam 500 MG Tablet for Oral Suspension [Spritam]1736050 | 18 / 18 | 0 | 0 | 0 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — levetiracetam 250 MG Tablet for Oral Suspension [Spritam]
Spritam has 2 products in the corpus; this table is for levetiracetam 250 MG Tablet for Oral Suspension [Spritam], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Blue Cross Medicare Advantage Access (PPO) | H1666-021 | 4 | No | No | No |
| Blue Cross Medicare Advantage Balance (PPO) | H1666-019 | 4 | No | No | No |
| Blue Cross Medicare Advantage Balance (PPO) | H1666-023 | 4 | No | No | No |
| Blue Cross Medicare Advantage Choice Plus (PPO) | H1666-006 | 4 | No | No | No |
| Blue Cross Medicare Advantage Choice Plus (PPO) | H1666-008 | 4 | No | No | No |
| Blue Cross Medicare Advantage Choice Premier (PPO) | H1666-003 | 4 | No | No | No |
| Blue Cross Medicare Advantage Choice Premier (PPO) | H1666-012 | 4 | No | No | No |
| Blue Cross Medicare Advantage Dental Premier (PPO) | H1666-016 | 4 | No | No | No |
| Blue Cross Medicare Advantage Dental Value (HMO) | H9706-007 | 4 | No | No | No |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | H9706-002 | 1 | No | No | No |
| Blue Cross Medicare Advantage Health Choice (PPO) | H1666-014 | 4 | No | No | No |
| Blue Cross Medicare Advantage Optimum (PPO) | H1666-020 | 4 | No | No | No |
| Blue Cross Medicare Advantage Optimum (PPO) | H1666-022 | 4 | No | No | No |
| Blue Cross Medicare Advantage Optimum (PPO) | H1666-024 | 4 | No | No | No |
| Blue Cross Medicare Advantage Saver (HMO) | H9706-008 | 4 | No | No | No |
| Blue Cross Medicare Advantage Secure (HMO) | H9706-005 | 4 | No | No | No |
| Blue Cross Medicare Advantage Value (HMO) | H9706-001 | 4 | No | No | No |
| Blue Cross Medicare Advantage Value (HMO) | H9706-009 | 4 | No | No | No |
- 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.
Spritam 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.