No prior authorization
Does Humana require prior authorization for Spritam?
Humana 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.
- No prior authorization is filed, but step therapy applies on 817 of 817 covering plans — the plan requires another drug be tried first.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| levetiracetam 250 MG Tablet for Oral Suspension [Spritam]1736047 | 817 / 817 | 0 | 817 | 817 | No prior authorization |
| levetiracetam 500 MG Tablet for Oral Suspension [Spritam]1736050 | 817 / 817 | 0 | 817 | 817 | 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 |
|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP) | S5884-101 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-102 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-103 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-104 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-105 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-106 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-107 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-108 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-109 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-110 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-111 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-112 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-113 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-114 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-115 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-116 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-131 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-132 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-133 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-134 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-135 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-136 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-137 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-138 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-139 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-140 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-141 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-142 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-143 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-144 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-145 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-146 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-147 | 4 | No | Yes | Yes |
| Humana Basic Rx Plan (PDP) | S5884-216 | 4 | No | Yes | Yes |
| Humana Cleveland Clinic Preferred (HMO-POS) | H6622-023 | 4 | No | Yes | Yes |
| Humana Community (HMO-POS) | H4623-002 | 4 | No | Yes | Yes |
| Humana Community (HMO) | H0292-001 | 4 | No | Yes | Yes |
| Humana Community (HMO) | H1036-236 | 4 | No | Yes | Yes |
| Humana Community (HMO) | H1036-332 | 4 | No | Yes | Yes |
| Humana Community (HMO) | H5178-002 | 4 | No | Yes | Yes |
| Humana Community (HMO) | H5619-159 | 4 | No | Yes | Yes |
| Humana Community HMO Diabetes and Heart (HMO C-SNP) | H1036-234 | 4 | No | Yes | Yes |
| Humana Community HMO Diabetes and Heart (HMO C-SNP) | H1468-017 | 4 | No | Yes | Yes |
| Humana Community HMO SNP-DE (HMO D-SNP) | H1036-235 | 4 | No | Yes | Yes |
| Humana Direct Choice Giveback (PPO) | H5216-406 | 4 | No | Yes | Yes |
| Humana Direct Choice Giveback (PPO) | H5216-424 | 4 | No | Yes | Yes |
| Humana Direct Choice Giveback (PPO) | H5216-431 | 4 | No | Yes | Yes |
| Humana Direct Choice Giveback (PPO) | H5216-452 | 4 | No | Yes | Yes |
| Humana Direct Choice Giveback (PPO) | H5970-031 | 4 | No | Yes | Yes |
| Humana Direct Choice Giveback (PPO) | H7617-112 | 4 | No | Yes | Yes |
| Humana Direct Choice GIveback (PPO) | H5970-032 | 4 | No | Yes | Yes |
| Humana Dual Fully Integrated (HMO D-SNP) | H4329-001 | 4 | No | Yes | Yes |
| Humana Dual Fully Integrated H2875-001 (HMO-POS D-SNP) | H2875-001 | 4 | No | Yes | Yes |
| Humana Dual Fully Integrated H2875-003 (HMO D-SNP) | H2875-003 | 4 | No | Yes | Yes |
| Humana Dual Integrated (HMO D-SNP) | H0963-001 | 4 | No | Yes | Yes |
| Humana Dual Integrated (HMO D-SNP) | H1036-339 | 4 | No | Yes | Yes |
| Humana Dual Integrated (HMO D-SNP) | H1036-340 | 4 | No | Yes | Yes |
| Humana Dual Integrated (HMO D-SNP) | H1036-341 | 4 | No | Yes | Yes |
| Humana Dual Integrated (HMO D-SNP) | H1396-001 | 4 | No | Yes | Yes |
| Humana Dual Select H0028-078 (HMO D-SNP) | H0028-078 | 4 | No | Yes | Yes |
| Humana Dual Select H0028-079 (HMO D-SNP) | H0028-079 | 4 | No | Yes | Yes |
| Humana Dual Select H1036-307 (HMO D-SNP) | H1036-307 | 4 | No | Yes | Yes |
| Humana Dual Select H1036-329 (HMO D-SNP) | H1036-329 | 4 | No | Yes | Yes |
| Humana Dual Select H1951-056 (HMO D-SNP) | H1951-056 | 4 | No | Yes | Yes |
| Humana Dual Select H2875-005 (HMO D-SNP) | H2875-005 | 4 | No | Yes | Yes |
| Humana Dual Select H2875-006 (HMO-POS D-SNP) | H2875-006 | 4 | No | Yes | Yes |
| Humana Dual Select H4939-002 (HMO-POS D-SNP) | H4939-002 | 4 | No | Yes | Yes |
| Humana Dual Select H5216-206 (PPO D-SNP) | H5216-206 | 4 | No | Yes | Yes |
| Humana Dual Select H5216-298 (PPO D-SNP) | H5216-298 | 4 | No | Yes | Yes |
| Humana Dual Select H5216-361 (PPO D-SNP) | H5216-361 | 4 | No | Yes | Yes |
| Humana Dual Select H5216-385 (PPO D-SNP) | H5216-385 | 4 | No | Yes | Yes |
| Humana Dual Select H5525-046 (PPO D-SNP) | H5525-046 | 4 | No | Yes | Yes |
| Humana Dual Select H5525-072 (PPO D-SNP) | H5525-072 | 4 | No | Yes | Yes |
| Humana Dual Select H5619-075 (HMO D-SNP) | H5619-075 | 4 | No | Yes | Yes |
| Humana Dual Select H5619-093 (HMO D-SNP) | H5619-093 | 4 | No | Yes | Yes |
| Humana Dual Select H5619-126 (HMO-POS D-SNP) | H5619-126 | 4 | No | Yes | Yes |
| Humana Dual Select H5619-165 (HMO D-SNP) | H5619-165 | 4 | No | Yes | Yes |
| Humana Dual Select H6622-027 (HMO-POS D-SNP) | H6622-027 | 4 | No | Yes | Yes |
| Humana Dual Select H7617-039 (PPO D-SNP) | H7617-039 | 4 | No | Yes | Yes |
| Humana Dual Select H7617-074 (PPO D-SNP) | H7617-074 | 4 | No | Yes | Yes |
| Humana Dual Select H7617-083 (PPO D-SNP) | H7617-083 | 4 | No | Yes | Yes |
| Humana Essentials Plus Giveback H0028-063 (HMO) | H0028-063 | 4 | No | Yes | Yes |
| Humana Essentials Plus Giveback H1036-271 (HMO) | H1036-271 | 4 | No | Yes | Yes |
| Humana Essentials Plus Giveback H5216-308 (PPO) | H5216-308 | 4 | No | Yes | Yes |
| Humana Essentials Plus Giveback H5216-358 (PPO) | H5216-358 | 4 | No | Yes | Yes |
| Humana Essentials Plus Giveback H5216-405 (PPO) | H5216-405 | 4 | No | Yes | Yes |
| Humana Essentials Plus Giveback H5216-429 (PPO) | H5216-429 | 4 | No | Yes | Yes |
| Humana Essentials Plus Giveback H5216-430 (PPO) | H5216-430 | 4 | No | Yes | Yes |
| Humana Essentials Plus Giveback H5216-435 (PPO) | H5216-435 | 4 | No | Yes | Yes |
| Humana Essentials Plus Giveback H5216-435 (PPO) | H5216-435 | 4 | No | Yes | Yes |
| Humana Essentials Plus Giveback H5216-435 (PPO) | H5216-435 | 4 | No | Yes | Yes |
| Humana Essentials Plus Giveback H7617-017 (PPO) | H7617-017 | 4 | No | Yes | Yes |
| Humana Essentials Plus Giveback H7617-024 (PPO) | H7617-024 | 4 | No | Yes | Yes |
| Humana Essentials Plus Giveback H7617-035 (PPO) | H7617-035 | 4 | No | Yes | Yes |
| Humana Essentials Plus Giveback H7617-100 (PPO) | H7617-100 | 4 | No | Yes | Yes |
| Humana FMOL Baton Rouge H1951-053 (HMO) | H1951-053 | 4 | No | Yes | Yes |
| Humana Full Access Giveback H5216-306 (PPO) | H5216-306 | 4 | No | Yes | Yes |
| Humana Full Access Giveback H5216-311 (PPO) | H5216-311 | 4 | No | Yes | Yes |
| Humana Full Access Giveback H5216-393 (PPO) | H5216-393 | 4 | No | Yes | Yes |
| Humana Full Access Giveback H7617-058 (PPO) | H7617-058 | 4 | No | Yes | Yes |
Showing 100 of 817 covering plans.
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.
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.