No prior authorization
Does Medical Mutual Of Ohio require prior authorization for Xarelto Kit?
Medical Mutual Of Ohio 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 | 16 / 16 | 0 | 0 | 16 | 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 |
|---|---|---|---|---|---|
| MedMutual Advantage Access (PPO) | H4497-005 | 3 | No | No | Yes |
| MedMutual Advantage Access (PPO) | H4497-005 | 3 | No | No | Yes |
| MedMutual Advantage Choice (HMO) | H6723-002 | 3 | No | No | Yes |
| MedMutual Advantage Choice (HMO) | H6723-002 | 3 | No | No | Yes |
| MedMutual Advantage Classic (HMO) | H6723-001 | 3 | No | No | Yes |
| MedMutual Advantage Classic (HMO) | H6723-001 | 3 | No | No | Yes |
| MedMutual Advantage Plus (HMO) | H6723-003 | 3 | No | No | Yes |
| MedMutual Advantage Plus (HMO) | H6723-003 | 3 | No | No | Yes |
| MedMutual Advantage Preferred (PPO) | H4497-002 | 3 | No | No | Yes |
| MedMutual Advantage Preferred (PPO) | H4497-002 | 3 | No | No | Yes |
| MedMutual Advantage Premium (PPO) | H4497-003 | 3 | No | No | Yes |
| MedMutual Advantage Premium (PPO) | H4497-003 | 3 | No | No | Yes |
| MedMutual Advantage Select (PPO) | H4497-001 | 3 | No | No | Yes |
| MedMutual Advantage Select (PPO) | H4497-001 | 3 | No | No | Yes |
| MedMutual Advantage Signature (HMO-POS) | H6723-006 | 3 | No | No | Yes |
| MedMutual Advantage Signature (HMO-POS) | H6723-006 | 3 | No | 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.
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.