Prior authorization required

Does Medica Health Plans require prior authorization for Inqovi 5 Tablet Pack?

Medica Health Plans requires prior authorization for Inqovi 5 Tablet Pack 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
{5 (cedazuridine 100 MG / decitabine 35 MG Oral Tablet [Inqovi]) } Pack [Inqovi 5 Tablet Pack]2384465	17 / 17	17	0	17	Prior authorization required

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

Plan-by-plan detail — {5 (cedazuridine 100 MG / decitabine 35 MG Oral Tablet [Inqovi]) } Pack [Inqovi 5 Tablet Pack]

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
Medica Advantage Dual (PPO D-SNP)	H8889-016	5	Yes	No	Yes
Medica Advantage Preferred (PPO)	H8889-011	5	Yes	No	Yes
Medica Advantage Preferred (PPO)	H8889-013	5	Yes	No	Yes
Medica Advantage Select (PPO)	H8889-012	5	Yes	No	Yes
Medica Advantage Select (PPO)	H8889-015	5	Yes	No	Yes
Medica Advantage Select (PPO)	H8889-018	5	Yes	No	Yes
Medica Advantage Solution H6154-001 (HMO-POS)	H6154-001	5	Yes	No	Yes
Medica Advantage Solution H8889-001 (PPO)	H8889-001	5	Yes	No	Yes
Medica Advantage Solution H8889-002 (PPO)	H8889-002	5	Yes	No	Yes
Medica Advantage Solution H8889-003 (PPO)	H8889-003	5	Yes	No	Yes
Medica Advantage Solution H8889-004 (PPO)	H8889-004	5	Yes	No	Yes
Medica Advantage Solution H8889-005 (PPO)	H8889-005	5	Yes	No	Yes
Medica Advantage Solution H8889-008 (PPO)	H8889-008	5	Yes	No	Yes
Medica Advantage Value (PPO)	H8889-010	5	Yes	No	Yes
Medica Advantage Value (PPO)	H8889-014	5	Yes	No	Yes
Medica Advantage Value (PPO)	H8889-017	5	Yes	No	Yes
Medica DUAL Solution (HMO D-SNP)	H2458-002	5	Yes	No	Yes

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.

Inqovi 5 Tablet Pack at other payers

Or see Inqovi 5 Tablet Pack 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.