Benefily
No prior authorization

Does Medica Health Plans require prior authorization for NovoLog Mix?

Medica Health Plans does not require prior authorization for NovoLog Mix 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 productPlans coveringRequire prior authStep therapyQty limitStatus
3 ML insulin aspart protamine, human 70 UNT/ML / insulin aspart, human 30 UNT/ML Pen Injector [NovoLog Mix]97784017 / 17000No prior authorization
insulin aspart protamine, human 70 UNT/ML / insulin aspart, human 30 UNT/ML Injectable Suspension [NovoLog Mix]97784217 / 17000No prior authorization

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

Plan-by-plan detail — 3 ML insulin aspart protamine, human 70 UNT/ML / insulin aspart, human 30 UNT/ML Pen Injector [NovoLog Mix]

NovoLog Mix has 2 products in the corpus; this table is for 3 ML insulin aspart protamine, human 70 UNT/ML / insulin aspart, human 30 UNT/ML Pen Injector [NovoLog Mix], the one carried on the most plans. The product table above covers every strength.

PlanContractTierPrior authStep therapyQty limit
Medica Advantage Dual (PPO D-SNP)H8889-0163NoNoNo
Medica Advantage Preferred (PPO)H8889-0113NoNoNo
Medica Advantage Preferred (PPO)H8889-0133NoNoNo
Medica Advantage Select (PPO)H8889-0123NoNoNo
Medica Advantage Select (PPO)H8889-0153NoNoNo
Medica Advantage Select (PPO)H8889-0183NoNoNo
Medica Advantage Solution H6154-001 (HMO-POS)H6154-0013NoNoNo
Medica Advantage Solution H8889-001 (PPO)H8889-0013NoNoNo
Medica Advantage Solution H8889-002 (PPO)H8889-0023NoNoNo
Medica Advantage Solution H8889-003 (PPO)H8889-0033NoNoNo
Medica Advantage Solution H8889-004 (PPO)H8889-0043NoNoNo
Medica Advantage Solution H8889-005 (PPO)H8889-0053NoNoNo
Medica Advantage Solution H8889-008 (PPO)H8889-0083NoNoNo
Medica Advantage Value (PPO)H8889-0103NoNoNo
Medica Advantage Value (PPO)H8889-0143NoNoNo
Medica Advantage Value (PPO)H8889-0173NoNoNo
Medica DUAL Solution (HMO D-SNP)H2458-0023NoNoNo
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.

NovoLog Mix at other payers

Or see NovoLog Mix 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.