Does Meridian Health Plan Of Illinois, INC. require prior authorization for Vizimpro?
Meridian Health Plan Of Illinois, INC. requires prior authorization for Vizimpro 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 |
|---|---|---|---|---|---|
| dacomitinib 15 MG Oral Tablet [Vizimpro]2058922 | 5 / 5 | 5 | 0 | 5 | Prior authorization required |
| dacomitinib 30 MG Oral Tablet [Vizimpro]2058926 | 5 / 5 | 5 | 0 | 5 | Prior authorization required |
| dacomitinib 45 MG Oral Tablet [Vizimpro]2058932 | 5 / 5 | 5 | 0 | 5 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — dacomitinib 15 MG Oral Tablet [Vizimpro]
Vizimpro has 3 products in the corpus; this table is for dacomitinib 15 MG Oral Tablet [Vizimpro], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Wellcare Giveback (HMO) | H5779-010 | 5 | Yes | No | Yes |
| Wellcare Meridian Dual Align (HMO D-SNP) | H6971-001 | 5 | Yes | No | Yes |
| Wellcare Simple Essential (HMO) | H5779-002 | 5 | Yes | No | Yes |
| Wellcare Simple Essential Value (HMO) | H5779-009 | 5 | Yes | No | Yes |
| Wellcare Simple Exclusive (HMO) | H5779-007 | 5 | Yes | No | Yes |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
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Vizimpro 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.