Prior authorization required

Does Kaiser Permanente require prior authorization for Gengraf?

Kaiser Permanente requires prior authorization for Gengraf 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
cyclosporine, modified 100 MG Oral Capsule [Gengraf]835835	115 / 115	115	0	0	Prior authorization required
cyclosporine, modified 25 MG Oral Capsule [Gengraf]835896	115 / 115	115	0	0	Prior authorization required

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

Plan-by-plan detail — cyclosporine, modified 100 MG Oral Capsule [Gengraf]

Gengraf has 2 products in the corpus; this table is for cyclosporine, modified 100 MG Oral Capsule [Gengraf], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
Kaiser Permanente Dual Complete (HMO D-SNP)	H0630-027	2	Yes	No	No
Kaiser Permanente Dual Complete (HMO D-SNP)	H1170-015	2	Yes	No	No
Kaiser Permanente Dual Complete Maui (HMO D-SNP)	H2704-016	2	Yes	No	No
Kaiser Permanente Dual Complete North P16 (HMO D-SNP)	H8794-016	2	Yes	No	No
Kaiser Permanente Dual Complete North P17 (HMO D-SNP)	H8794-017	2	Yes	No	No
Kaiser Permanente Dual Complete North P18 (HMO D-SNP)	H8794-018	2	Yes	No	No
Kaiser Permanente Dual Complete North P19 (HMO D-SNP)	H8794-019	2	Yes	No	No
Kaiser Permanente Dual Complete North P2 (HMO D-SNP)	H8794-002	2	Yes	No	No
Kaiser Permanente Dual Complete North P20 (HMO D-SNP)	H8794-020	2	Yes	No	No
Kaiser Permanente Dual Complete North P21 (HMO D-SNP)	H8794-021	2	Yes	No	No
Kaiser Permanente Dual Complete North P22 (HMO D-SNP)	H8794-022	2	Yes	No	No
Kaiser Permanente Dual Complete North P23 (HMO D-SNP)	H8794-023	2	Yes	No	No
Kaiser Permanente Dual Complete North P24 (HMO D-SNP)	H8794-024	2	Yes	No	No
Kaiser Permanente Dual Complete North P25 (HMO D-SNP)	H8794-025	2	Yes	No	No
Kaiser Permanente Dual Complete Oahu (HMO D-SNP)	H2704-015	2	Yes	No	No
Kaiser Permanente Dual Complete Plan 1 MD (HMO D-SNP)	H2172-016	2	Yes	No	No
Kaiser Permanente Dual Complete Plan 2 MD (HMO D-SNP)	H2172-017	2	Yes	No	No
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP)	H0630-024	2	Yes	No	No
Kaiser Permanente Dual Complete South P1 (HMO D-SNP)	H8794-001	2	Yes	No	No
Kaiser Permanente Dual Complete South P10 (HMO D-SNP)	H8794-010	2	Yes	No	No
Kaiser Permanente Dual Complete South P11 (HMO D-SNP)	H8794-011	2	Yes	No	No
Kaiser Permanente Dual Complete South P6 (HMO D-SNP)	H8794-006	2	Yes	No	No
Kaiser Permanente Dual Complete South P7 (HMO D-SNP)	H8794-007	2	Yes	No	No
Kaiser Permanente Dual Complete South P9 (HMO D-SNP)	H8794-009	2	Yes	No	No
Kaiser Permanente Dual Essential (HMO D-SNP)	H0630-014	2	Yes	No	No
Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP)	H1170-008	2	Yes	No	No
Kaiser Permanente Dual Essential Plan 1 MD (HMO D-SNP)	H2172-018	2	Yes	No	No
Kaiser Permanente Dual Essential Plan 2 (HMO D-SNP)	H1170-011	2	Yes	No	No
Kaiser Permanente Dual Essential Plan 2 MD (HMO D-SNP)	H2172-019	2	Yes	No	No
Kaiser Permanente Medicare Advantage Anchor (HMO)	H5050-023	2	Yes	No	No
Kaiser Permanente Medicare Advantage Care Plus MD (HMO-POS)	H2172-014	2	Yes	No	No
Kaiser Permanente Medicare Advantage Care Plus VA (HMO-POS)	H2172-013	2	Yes	No	No
Kaiser Permanente Medicare Advantage Centennial (HMO)	H5050-021	2	Yes	No	No
Kaiser Permanente Medicare Advantage Columbia (HMO)	H5050-019	2	Yes	No	No
Kaiser Permanente Medicare Advantage Essential (HMO)	H5050-009	2	Yes	No	No
Kaiser Permanente Medicare Advantage Essential Kng (HMO)	H5050-024	2	Yes	No	No
Kaiser Permanente Medicare Advantage Essential Pce (HMO)	H5050-025	2	Yes	No	No
Kaiser Permanente Medicare Advantage Essential Sno (HMO)	H5050-026	2	Yes	No	No
Kaiser Permanente Medicare Advantage Essential Thu (HMO)	H5050-027	2	Yes	No	No
Kaiser Permanente Medicare Advantage Harbor (HMO)	H5050-017	2	Yes	No	No
Kaiser Permanente Medicare Advantage High DC (HMO-POS)	H2172-001	2	Yes	No	No
Kaiser Permanente Medicare Advantage High MD (HMO-POS)	H2172-002	2	Yes	No	No
Kaiser Permanente Medicare Advantage High VA (HMO-POS)	H2172-008	2	Yes	No	No
Kaiser Permanente Medicare Advantage Key (HMO)	H5050-022	2	Yes	No	No
Kaiser Permanente Medicare Advantage Key King (HMO)	H5050-028	2	Yes	No	No
Kaiser Permanente Medicare Advantage Key Pierce (HMO)	H5050-029	2	Yes	No	No
Kaiser Permanente Medicare Advantage Key Snohomish (HMO)	H5050-030	2	Yes	No	No
Kaiser Permanente Medicare Advantage Key Thurston (HMO)	H5050-031	2	Yes	No	No
Kaiser Permanente Medicare Advantage Optimal (HMO)	H5050-004	2	Yes	No	No
Kaiser Permanente Medicare Advantage Standard 1 MD (HMO-POS)	H2172-021	2	Yes	No	No
Kaiser Permanente Medicare Advantage Standard 1 VA (HMO-POS)	H2172-009	2	Yes	No	No
Kaiser Permanente Medicare Advantage Standard 2 MD (HMO-POS)	H2172-022	2	Yes	No	No
Kaiser Permanente Medicare Advantage Standard 2 VA (HMO-POS)	H2172-023	2	Yes	No	No
Kaiser Permanente Medicare Advantage Standard DC (HMO-POS)	H2172-020	2	Yes	No	No
Kaiser Permanente Medicare Advantage Value 1 MD (HMO)	H2172-025	2	Yes	No	No
Kaiser Permanente Medicare Advantage Value 1 VA (HMO-POS)	H2172-010	2	Yes	No	No
Kaiser Permanente Medicare Advantage Value 2 MD (HMO)	H2172-026	2	Yes	No	No
Kaiser Permanente Medicare Advantage Value 2 VA (HMO-POS)	H2172-024	2	Yes	No	No
Kaiser Permanente Medicare Advantage Value DC (HMO-POS)	H2172-027	2	Yes	No	No
Kaiser Permanente Medicare Advantage Vital Sound (HMO)	H5050-032	2	Yes	No	No
Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO)	H0524-032	2	Yes	No	No
Kaiser Permanente Senior Advantage Basic (HMO)	H1230-003	2	Yes	No	No
Kaiser Permanente Senior Advantage Basic 1 (HMO)	H1170-009	2	Yes	No	No
Kaiser Permanente Senior Advantage Basic 2 (HMO)	H1170-012	2	Yes	No	No
Kaiser Permanente Senior Advantage Basic Alameda (HMO)	H0524-059	2	Yes	No	No
Kaiser Permanente Senior Advantage Basic Fresno (HMO)	H0524-046	2	Yes	No	No
Kaiser Permanente Senior Advantage Basic Kern (HMO)	H0524-036	2	Yes	No	No
Kaiser Permanente Senior Advantage Basic Marin (HMO)	H0524-064	2	Yes	No	No
Kaiser Permanente Senior Advantage Basic San Mateo (HMO)	H0524-065	2	Yes	No	No
Kaiser Permanente Senior Advantage Basic SF (HMO)	H0524-060	2	Yes	No	No
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO)	H0524-043	2	Yes	No	No
Kaiser Permanente Senior Advantage Basic Solano (HMO)	H0524-063	2	Yes	No	No
Kaiser Permanente Senior Advantage Basic Stanis (HMO)	H0524-041	2	Yes	No	No
Kaiser Permanente Senior Advantage Bronze DM (HMO-POS)	H0630-025	2	Yes	No	No
Kaiser Permanente Senior Advantage Care Plus (HMO-POS)	H1170-013	2	Yes	No	No
Kaiser Permanente Senior Advantage Choice DM (PPO)	H3138-001	2	Yes	No	No
Kaiser Permanente Senior Advantage Choice North (PPO)	H3138-003	2	Yes	No	No
Kaiser Permanente Senior Advantage Choice South (PPO)	H3138-002	2	Yes	No	No
Kaiser Permanente Senior Advantage Core DM (HMO)	H0630-013	2	Yes	No	No
Kaiser Permanente Senior Advantage Core North (HMO)	H0630-020	2	Yes	No	No
Kaiser Permanente Senior Advantage Core South (HMO)	H0630-017	2	Yes	No	No
Kaiser Permanente Senior Advantage Enhanced (HMO-POS)	H0630-023	2	Yes	No	No
Kaiser Permanente Senior Advantage Enhanced (HMO-POS)	H9003-001	2	Yes	No	No
Kaiser Permanente Senior Advantage Enhanced (HMO)	H1230-001	2	Yes	No	No
Kaiser Permanente Senior Advantage Enhanced 1 (HMO)	H1170-002	2	Yes	No	No
Kaiser Permanente Senior Advantage Enhanced Fresno (HMO)	H0524-038	2	Yes	No	No
Kaiser Permanente Senior Advantage Enhanced Kern (HMO)	H0524-035	2	Yes	No	No
Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO)	H0524-042	2	Yes	No	No
Kaiser Permanente Senior Advantage Enhanced Solano (HMO)	H0524-008	2	Yes	No	No
Kaiser Permanente Senior Advantage Enhanced Stanis (HMO)	H0524-040	2	Yes	No	No
Kaiser Permanente Senior Advantage Gold (HMO-POS)	H0630-016	2	Yes	No	No
Kaiser Permanente Senior Advantage Hawaii Island (HMO)	H1230-014	2	Yes	No	No
Kaiser Permanente Senior Advantage Inland Empire (HMO)	H0524-015	2	Yes	No	No
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)	H0524-003	2	Yes	No	No
Kaiser Permanente Senior Advantage Maui (HMO)	H1230-013	2	Yes	No	No
Kaiser Permanente Senior Advantage San Diego (HMO)	H0524-037	2	Yes	No	No
Kaiser Permanente Senior Advantage San Diego Value (HMO)	H0524-082	2	Yes	No	No
Kaiser Permanente Senior Advantage Santa Cruz (HMO)	H0524-054	2	Yes	No	No
Kaiser Permanente Senior Advantage Silver DM (HMO-POS)	H0630-015	2	Yes	No	No
Kaiser Permanente Senior Advantage Silver North (HMO-POS)	H0630-021	2	Yes	No	No

Showing 100 of 115 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.

Gengraf at other payers

Or see Gengraf 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.