Does Keystone Health Plan East, INC. require prior authorization for Emgality?
Keystone Health Plan East, INC. requires prior authorization for Emgality 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 |
|---|---|---|---|---|---|
| 1 ML galcanezumab-gnlm 120 MG/ML Auto-Injector [Emgality]2058877 | 8 / 8 | 8 | 0 | 8 | Prior authorization required |
| 1 ML galcanezumab-gnlm 120 MG/ML Prefilled Syringe [Emgality]2058887 | 8 / 8 | 8 | 0 | 8 | Prior authorization required |
| 1 ML galcanezumab-gnlm 100 MG/ML Prefilled Syringe [Emgality]2170613 | 8 / 8 | 8 | 0 | 8 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — 1 ML galcanezumab-gnlm 120 MG/ML Auto-Injector [Emgality]
Emgality has 3 products in the corpus; this table is for 1 ML galcanezumab-gnlm 120 MG/ML Auto-Injector [Emgality], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Keystone 65 Basic Rx (HMO) | H3952-055 | 3 | Yes | No | Yes |
| Keystone 65 Essential Rx (HMO-POS) | H3952-060 | 3 | Yes | No | Yes |
| Keystone 65 Focus Rx (HMO-POS) | H3952-053 | 3 | Yes | No | Yes |
| Keystone 65 Focus Rx (HMO-POS) | H3952-054 | 3 | Yes | No | Yes |
| Keystone 65 Preferred Rx (HMO) | H3952-020 | 3 | Yes | No | Yes |
| Keystone 65 Preferred Rx (HMO) | H3952-045 | 3 | Yes | No | Yes |
| Keystone 65 Select Rx (HMO) | H3952-049 | 3 | Yes | No | Yes |
| Keystone 65 Select Rx (HMO) | H3952-051 | 3 | Yes | No | Yes |
- 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.
Emgality 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.