Does Medica Health Plans require prior authorization for Procrit?
Prior authorization for Procrit differs across Medica Health Plans's Medicare Part D plans and product strengths — 5 of 6 Procrit products in the corpus appear on their formularies, and the requirement is not uniform. Check the member's specific plan.
Some plans require authorization and others do not. The member's specific plan decides.
- 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 |
|---|---|---|---|---|---|
| 1 ML epoetin alfa 10000 UNT/ML Injection [Procrit]1721690 | 17 / 17 | 17 | 0 | 0 | Prior authorization required |
| 1 ML epoetin alfa 2000 UNT/ML Injection [Procrit]205918 | 17 / 17 | 17 | 0 | 0 | Prior authorization required |
| 1 ML epoetin alfa 3000 UNT/ML Injection [Procrit]205922 | 17 / 17 | 17 | 0 | 0 | Prior authorization required |
| 1 ML epoetin alfa 4000 UNT/ML Injection [Procrit]205924 | 17 / 17 | 17 | 0 | 0 | Prior authorization required |
| epoetin alfa 20000 UNT/ML Injectable Solution [Procrit]212219 | 17 / 17 | 17 | 0 | 0 | Prior authorization required |
| 1 ML epoetin alfa 40000 UNT/ML Injection [Procrit]213475 | 0 / 17 | 0 | 0 | 0 | Not on formulary |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — 1 ML epoetin alfa 10000 UNT/ML Injection [Procrit]
Procrit has 6 products in the corpus; this table is for 1 ML epoetin alfa 10000 UNT/ML Injection [Procrit], 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 | 3 | Yes | No | No |
| Medica Advantage Preferred (PPO) | H8889-011 | 3 | Yes | No | No |
| Medica Advantage Preferred (PPO) | H8889-013 | 3 | Yes | No | No |
| Medica Advantage Select (PPO) | H8889-012 | 3 | Yes | No | No |
| Medica Advantage Select (PPO) | H8889-015 | 3 | Yes | No | No |
| Medica Advantage Select (PPO) | H8889-018 | 3 | Yes | No | No |
| Medica Advantage Solution H6154-001 (HMO-POS) | H6154-001 | 3 | Yes | No | No |
| Medica Advantage Solution H8889-001 (PPO) | H8889-001 | 3 | Yes | No | No |
| Medica Advantage Solution H8889-002 (PPO) | H8889-002 | 3 | Yes | No | No |
| Medica Advantage Solution H8889-003 (PPO) | H8889-003 | 3 | Yes | No | No |
| Medica Advantage Solution H8889-004 (PPO) | H8889-004 | 3 | Yes | No | No |
| Medica Advantage Solution H8889-005 (PPO) | H8889-005 | 3 | Yes | No | No |
| Medica Advantage Solution H8889-008 (PPO) | H8889-008 | 3 | Yes | No | No |
| Medica Advantage Value (PPO) | H8889-010 | 3 | Yes | No | No |
| Medica Advantage Value (PPO) | H8889-014 | 3 | Yes | No | No |
| Medica Advantage Value (PPO) | H8889-017 | 3 | Yes | No | No |
| Medica DUAL Solution (HMO D-SNP) | H2458-002 | 3 | Yes | No | No |
- 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.
Procrit 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.