Prior authorization required

Does Health Insurance Plan Of Greater New York require prior authorization for Signifor?

Health Insurance Plan Of Greater New York requires prior authorization for Signifor 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	Status
1 ML pasireotide 0.3 MG/ML Injection [Signifor]1364114	10 / 10	10	Prior authorization required
1 ML pasireotide 0.6 MG/ML Injection [Signifor]1364118	10 / 10	10	Prior authorization required
1 ML pasireotide 0.9 MG/ML Injection [Signifor]1364122	10 / 10	10	Prior authorization required

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

Plan-by-plan detail — 1 ML pasireotide 0.3 MG/ML Injection [Signifor]

Signifor has 3 products in the corpus; this table is for 1 ML pasireotide 0.3 MG/ML Injection [Signifor], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
EmblemHealth VIP Dual (HMO D-SNP)	H5991-012	5	Yes	No	No
EmblemHealth VIP Dual (HMO D-SNP)	H5991-012	5	Yes	No	No
EmblemHealth VIP Dual Enhanced (HMO D-SNP)	H5991-013	5	Yes	No	No
EmblemHealth VIP Dual Enhanced (HMO D-SNP)	H5991-013	5	Yes	No	No
EmblemHealth VIP Dual Reserve (HMO D-SNP)	H5991-010	5	Yes	No	No
EmblemHealth VIP Gold (HMO)	H3330-021	5	Yes	No	No
EmblemHealth VIP Gold (HMO)	H3330-021	5	Yes	No	No
EmblemHealth VIP Gold (HMO)	H3330-021	5	Yes	No	No
EmblemHealth VIP Gold Plus (HMO)	H3330-038	5	Yes	No	No
EmblemHealth VIP Value (HMO-POS)	H3330-048	5	Yes	No	No

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.

Signifor at other payers

Or see Signifor 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.