Does Keystone Health Plan East, INC. require prior authorization for Rybelsus?
Keystone Health Plan East, INC. requires prior authorization for Rybelsus 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 |
|---|---|---|---|---|---|
| semaglutide 14 MG Oral Tablet [Rybelsus]2200650 | 8 / 8 | 8 | 0 | 8 | Prior authorization required |
| semaglutide 3 MG Oral Tablet [Rybelsus]2200654 | 8 / 8 | 8 | 0 | 8 | Prior authorization required |
| semaglutide 7 MG Oral Tablet [Rybelsus]2200658 | 8 / 8 | 8 | 0 | 8 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — semaglutide 14 MG Oral Tablet [Rybelsus]
Rybelsus has 3 products in the corpus; this table is for semaglutide 14 MG Oral Tablet [Rybelsus], 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
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Rybelsus 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.