Does Medica Health Plans require prior authorization for Fanapt?
Medica Health Plans does not require prior authorization for Fanapt on the Medicare Part D plans that cover it.
No covering plan from this payer files a prior-authorization requirement for this drug.
- No prior authorization is filed, but step therapy applies on 17 of 17 covering plans — the plan requires another drug be tried first.
- This drug does not appear on any of this payer's Medicare Part D formularies. That means it is NOT COVERED under those plans — which is a different and generally worse outcome than requiring prior authorization. An exception or formulary-exception request may still be possible.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| iloperidone 1 MG Oral Tablet [Fanapt]848726 | 17 / 17 | 0 | 17 | 17 | No prior authorization |
| iloperidone 10 MG Oral Tablet [Fanapt]848730 | 17 / 17 | 0 | 17 | 17 | No prior authorization |
| iloperidone 12 MG Oral Tablet [Fanapt]848734 | 17 / 17 | 0 | 17 | 17 | No prior authorization |
| iloperidone 2 MG Oral Tablet [Fanapt]848738 | 0 / 17 | 0 | 0 | 0 | Not on formulary |
| iloperidone 4 MG Oral Tablet [Fanapt]848742 | 0 / 17 | 0 | 0 | 0 | Not on formulary |
| iloperidone 6 MG Oral Tablet [Fanapt]848746 | 0 / 17 | 0 | 0 | 0 | Not on formulary |
| iloperidone 8 MG Oral Tablet [Fanapt]848750 | 0 / 17 | 0 | 0 | 0 | Not on formulary |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — iloperidone 1 MG Oral Tablet [Fanapt]
Fanapt has 7 products in the corpus; this table is for iloperidone 1 MG Oral Tablet [Fanapt], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Medica Advantage Dual (PPO D-SNP) | H8889-016 | 4 | No | Yes | Yes |
| Medica Advantage Preferred (PPO) | H8889-011 | 4 | No | Yes | Yes |
| Medica Advantage Preferred (PPO) | H8889-013 | 4 | No | Yes | Yes |
| Medica Advantage Select (PPO) | H8889-012 | 4 | No | Yes | Yes |
| Medica Advantage Select (PPO) | H8889-015 | 4 | No | Yes | Yes |
| Medica Advantage Select (PPO) | H8889-018 | 4 | No | Yes | Yes |
| Medica Advantage Solution H6154-001 (HMO-POS) | H6154-001 | 4 | No | Yes | Yes |
| Medica Advantage Solution H8889-001 (PPO) | H8889-001 | 4 | No | Yes | Yes |
| Medica Advantage Solution H8889-002 (PPO) | H8889-002 | 4 | No | Yes | Yes |
| Medica Advantage Solution H8889-003 (PPO) | H8889-003 | 4 | No | Yes | Yes |
| Medica Advantage Solution H8889-004 (PPO) | H8889-004 | 4 | No | Yes | Yes |
| Medica Advantage Solution H8889-005 (PPO) | H8889-005 | 4 | No | Yes | Yes |
| Medica Advantage Solution H8889-008 (PPO) | H8889-008 | 4 | No | Yes | Yes |
| Medica Advantage Value (PPO) | H8889-010 | 4 | No | Yes | Yes |
| Medica Advantage Value (PPO) | H8889-014 | 4 | No | Yes | Yes |
| Medica Advantage Value (PPO) | H8889-017 | 4 | No | Yes | Yes |
| Medica DUAL Solution (HMO D-SNP) | H2458-002 | 4 | No | Yes | Yes |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
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Fanapt 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.