Prior authorization required

Does Health Partners Plans, INC. require prior authorization for Gleostine?

Health Partners Plans, INC. requires prior authorization for Gleostine 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
lomustine 10 MG Oral Capsule [Gleostine]1545776	8 / 8	8	Prior authorization required
lomustine 100 MG Oral Capsule [Gleostine]1545778	8 / 8	8	Prior authorization required
lomustine 40 MG Oral Capsule [Gleostine]1545780	8 / 8	8	Prior authorization required

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

Plan-by-plan detail — lomustine 10 MG Oral Capsule [Gleostine]

Gleostine has 3 products in the corpus; this table is for lomustine 10 MG Oral Capsule [Gleostine], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
Jefferson Health Plans Complete (HMO)	H9207-012	4	Yes	No	No
Jefferson Health Plans Dual Pearl (HMO D-SNP)	H9207-016	4	Yes	No	No
Jefferson Health Plans Elite (HMO)	H9207-018	4	Yes	No	No
Jefferson Health Plans Giveback (HMO)	H9207-015	4	Yes	No	No
Jefferson Health Plans Prime (HMO)	H9207-002	4	Yes	No	No
Jefferson Health Plans Select (HMO D-SNP)	H9207-017	4	Yes	No	No
Jefferson Health Plans Silver (HMO)	H9207-013	4	Yes	No	No
Jefferson Health Plans Special (HMO D-SNP)	H9207-004	4	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.

Gleostine at other payers

Or see Gleostine 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.