Prior authorization required

Does Keystone Health Plan East, INC. require prior authorization for Trelstar?

Keystone Health Plan East, INC. requires prior authorization for Trelstar 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
triptorelin 22.5 MG Injection [Trelstar]905057	4 / 8	4	Prior authorization required
triptorelin 3.75 MG Injection [Trelstar]905059	4 / 8	4	Prior authorization required
triptorelin 11.25 MG Injection [Trelstar]905064	8 / 8	8	Prior authorization required

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

Plan-by-plan detail — triptorelin 11.25 MG Injection [Trelstar]

Trelstar has 3 products in the corpus; this table is for triptorelin 11.25 MG Injection [Trelstar], 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	4	Yes	No	No
Keystone 65 Essential Rx (HMO-POS)	H3952-060	4	Yes	No	No
Keystone 65 Focus Rx (HMO-POS)	H3952-053	4	Yes	No	No
Keystone 65 Focus Rx (HMO-POS)	H3952-054	4	Yes	No	No
Keystone 65 Preferred Rx (HMO)	H3952-020	4	Yes	No	No
Keystone 65 Preferred Rx (HMO)	H3952-045	4	Yes	No	No
Keystone 65 Select Rx (HMO)	H3952-049	4	Yes	No	No
Keystone 65 Select Rx (HMO)	H3952-051	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.

Trelstar at other payers

Or see Trelstar 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.