Benefily
Prior authorization required

Does Health Care Service Corporation require prior authorization for Tenivac?

Health Care Service Corporation requires prior authorization for Tenivac 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
0.5 ML diphtheria toxoid vaccine, inactivated 4 UNT/ML / tetanus toxoid vaccine, inactivated 10 UNT/ML Injection [Tenivac]119091631 / 313100Prior authorization required
0.5 ML diphtheria toxoid vaccine, inactivated 4 UNT/ML / tetanus toxoid vaccine, inactivated 10 UNT/ML Prefilled Syringe [Tenivac]119091931 / 313100Prior authorization required

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

Plan-by-plan detail — 0.5 ML diphtheria toxoid vaccine, inactivated 4 UNT/ML / tetanus toxoid vaccine, inactivated 10 UNT/ML Injection [Tenivac]

Tenivac has 2 products in the corpus; this table is for 0.5 ML diphtheria toxoid vaccine, inactivated 4 UNT/ML / tetanus toxoid vaccine, inactivated 10 UNT/ML Injection [Tenivac], the one carried on the most plans. The product table above covers every strength.

PlanContractTierPrior authStep therapyQty limit
Blue Cross MA Dual Care Plus Preferred (PPO D-SNP)H8634-0091YesNoNo
Blue Cross Medicare Advantage Balance (PPO)H8634-0311YesNoNo
Blue Cross Medicare Advantage Basic (HMO)H3822-0011YesNoNo
Blue Cross Medicare Advantage Basic (HMO)H3822-0021YesNoNo
Blue Cross Medicare Advantage Basic (HMO)H3822-0121YesNoNo
Blue Cross Medicare Advantage Basic Plus (HMO-POS)H3822-0071YesNoNo
Blue Cross Medicare Advantage Choice Plus (PPO)H0107-0051YesNoNo
Blue Cross Medicare Advantage Choice Plus (PPO)H8634-0031YesNoNo
Blue Cross Medicare Advantage Choice Premier (PPO)H8634-0041YesNoNo
Blue Cross Medicare Advantage Classic (PPO)H0107-0031YesNoNo
Blue Cross Medicare Advantage Classic (PPO)H8634-0081YesNoNo
Blue Cross Medicare Advantage Classic (PPO)H8634-0101YesNoNo
Blue Cross Medicare Advantage Classic (PPO)H8634-0221YesNoNo
Blue Cross Medicare Advantage Classic (PPO)H8634-0271YesNoNo
Blue Cross Medicare Advantage Complete (PPO)H8634-0231YesNoNo
Blue Cross Medicare Advantage Dental Premier (PPO)H0107-0071YesNoNo
Blue Cross Medicare Advantage Dental Premier (PPO)H8634-0211YesNoNo
Blue Cross Medicare Advantage Dental Premier (PPO)H8634-0241YesNoNo
Blue Cross Medicare Advantage Dental Premier (PPO)H8634-0291YesNoNo
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP)H3251-0291YesNoNo
Blue Cross Medicare Advantage Essential (PPO)H8634-0121YesNoNo
Blue Cross Medicare Advantage Health Choice (PPO)H0107-0101YesNoNo
Blue Cross Medicare Advantage Health Choice (PPO)H8634-0181YesNoNo
Blue Cross Medicare Advantage Health Choice (PPO)H8634-0251YesNoNo
Blue Cross Medicare Advantage Health Choice (PPO)H8634-0301YesNoNo
Blue Cross Medicare Advantage Optimum (PPO)H0107-0041YesNoNo
Blue Cross Medicare Advantage Optimum (PPO)H8634-0321YesNoNo
Blue Cross Medicare Advantage Preferred (PPO)H8634-0331YesNoNo
Blue Cross Medicare Advantage Premier Plus (HMO-POS)H3822-0081YesNoNo
Blue Cross Medicare Advantage Select (HMO)H3251-0021YesNoNo
Blue Cross Medicare Advantage Value (HMO)H3822-0141YesNoNo
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.

Tenivac at other payers

Or see Tenivac 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.