Does Health Care Service Corporation require prior authorization for Envarsus?
Health Care Service Corporation requires prior authorization for Envarsus 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 |
|---|---|---|---|---|---|
| 24 HR tacrolimus 4 MG Extended Release Oral Tablet [Envarsus]1664440 | 31 / 31 | 31 | 0 | 0 | Prior authorization required |
| 24 HR tacrolimus 0.75 MG Extended Release Oral Tablet [Envarsus]1664458 | 31 / 31 | 31 | 0 | 0 | Prior authorization required |
| 24 HR tacrolimus 1 MG Extended Release Oral Tablet [Envarsus]1664463 | 31 / 31 | 31 | 0 | 0 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — 24 HR tacrolimus 4 MG Extended Release Oral Tablet [Envarsus]
Envarsus has 3 products in the corpus; this table is for 24 HR tacrolimus 4 MG Extended Release Oral Tablet [Envarsus], 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 MA Dual Care Plus Preferred (PPO D-SNP) | H8634-009 | 1 | Yes | No | No |
| Blue Cross Medicare Advantage Balance (PPO) | H8634-031 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Basic (HMO) | H3822-001 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Basic (HMO) | H3822-002 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Basic (HMO) | H3822-012 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Basic Plus (HMO-POS) | H3822-007 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Choice Plus (PPO) | H0107-005 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Choice Plus (PPO) | H8634-003 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Choice Premier (PPO) | H8634-004 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Classic (PPO) | H0107-003 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Classic (PPO) | H8634-008 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Classic (PPO) | H8634-010 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Classic (PPO) | H8634-022 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Classic (PPO) | H8634-027 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Complete (PPO) | H8634-023 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Dental Premier (PPO) | H0107-007 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Dental Premier (PPO) | H8634-021 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Dental Premier (PPO) | H8634-024 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Dental Premier (PPO) | H8634-029 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | H3251-029 | 1 | Yes | No | No |
| Blue Cross Medicare Advantage Essential (PPO) | H8634-012 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Health Choice (PPO) | H0107-010 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Health Choice (PPO) | H8634-018 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Health Choice (PPO) | H8634-025 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Health Choice (PPO) | H8634-030 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Optimum (PPO) | H0107-004 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Optimum (PPO) | H8634-032 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Preferred (PPO) | H8634-033 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Premier Plus (HMO-POS) | H3822-008 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Select (HMO) | H3251-002 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Value (HMO) | H3822-014 | 5 | Yes | 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.
Envarsus 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.