Does Keystone Health Plan East, INC. require prior authorization for Xarelto Kit?
Keystone Health Plan East, INC. does not require prior authorization for Xarelto Kit on the Medicare Part D plans that cover it.
No covering plan from this payer files a prior-authorization requirement for this drug.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| {42 (rivaroxaban 15 MG Oral Tablet [Xarelto]) / 9 (rivaroxaban 20 MG Oral Tablet [Xarelto]) } Pack [Xarelto Kit]1549683 | 8 / 8 | 0 | 0 | 8 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — {42 (rivaroxaban 15 MG Oral Tablet [Xarelto]) / 9 (rivaroxaban 20 MG Oral Tablet [Xarelto]) } Pack [Xarelto Kit]
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Keystone 65 Basic Rx (HMO) | H3952-055 | 3 | No | No | Yes |
| Keystone 65 Essential Rx (HMO-POS) | H3952-060 | 3 | No | No | Yes |
| Keystone 65 Focus Rx (HMO-POS) | H3952-053 | 3 | No | No | Yes |
| Keystone 65 Focus Rx (HMO-POS) | H3952-054 | 3 | No | No | Yes |
| Keystone 65 Preferred Rx (HMO) | H3952-020 | 3 | No | No | Yes |
| Keystone 65 Preferred Rx (HMO) | H3952-045 | 3 | No | No | Yes |
| Keystone 65 Select Rx (HMO) | H3952-049 | 3 | No | No | Yes |
| Keystone 65 Select Rx (HMO) | H3952-051 | 3 | No | No | Yes |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
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Xarelto Kit 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.