Prior authorization required
Does Molina Healthcare require prior authorization for Alvaiz?
Molina Healthcare requires prior authorization for Alvaiz 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 |
|---|---|---|---|---|---|
| eltrombopag 18 MG Oral Tablet [Alvaiz]2675193 | 51 / 51 | 51 | 0 | 51 | Prior authorization required |
| eltrombopag 36 MG Oral Tablet [Alvaiz]2675197 | 51 / 51 | 51 | 0 | 51 | Prior authorization required |
| eltrombopag 54 MG Oral Tablet [Alvaiz]2675201 | 51 / 51 | 51 | 0 | 51 | Prior authorization required |
| eltrombopag 9 MG Oral Tablet [Alvaiz]2675205 | 51 / 51 | 51 | 0 | 51 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — eltrombopag 18 MG Oral Tablet [Alvaiz]
Alvaiz has 4 products in the corpus; this table is for eltrombopag 18 MG Oral Tablet [Alvaiz], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Molina Complete Care for MyCare Ohio (HMO D-SNP) | H9955-008 | 5 | Yes | No | Yes |
| Molina Dual MI Coordinated Health (HMO D-SNP) | H5926-008 | 5 | Yes | No | Yes |
| Molina Dual MI Coordinated Health (HMO D-SNP) | H5926-009 | 5 | Yes | No | Yes |
| Molina Medicare Choice Care (HMO) | H2715-003 | 5 | Yes | No | Yes |
| Molina Medicare Choice Care (HMO) | H5810-014 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H1799-004 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H1799-005 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H2478-001 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H2715-006 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H2715-006 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H5628-001 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H5628-013 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H5628-013 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H5823-013 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H5823-013 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H5926-001 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H7678-006 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H7678-006 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H8845-001 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H8845-004 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H8845-005 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H8845-007 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H8845-007 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care (HMO D-SNP) | H9955-007 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H3038-004 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H3038-004 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H3038-004 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H3038-004 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H3093-001 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H3093-002 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H3093-003 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H3093-004 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H3093-005 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H6515-001 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H6515-002 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H6515-003 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H6515-004 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H6515-005 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H8176-004 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care Plus (HMO D-SNP) | H8176-004 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care Select (HMO D-SNP) | H5628-012 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care Select (HMO D-SNP) | H5628-014 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care Select (HMO D-SNP) | H5628-014 | 5 | Yes | No | Yes |
| Molina Medicare Complete Care Select (HMO D-SNP) | H5823-010 | 5 | Yes | No | Yes |
| My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) | H5209-006 | 5 | Yes | No | Yes |
| My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) | H5209-006 | 5 | Yes | No | Yes |
| My Choice Wisconsin Partnership Plan (HMO D-SNP) | H5209-005 | 5 | Yes | No | Yes |
| My Choice Wisconsin Partnership Plan (HMO D-SNP) | H5209-005 | 5 | Yes | No | Yes |
| Passport Advantage (HMO D-SNP) | H1799-003 | 5 | Yes | No | Yes |
| Passport Advantage (HMO D-SNP) | H1799-003 | 5 | Yes | No | Yes |
| Passport Advantage (HMO D-SNP) | H1799-003 | 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.
Alvaiz at other payers
Or see Alvaiz across every payer at once.
- Aetna (CVS Health)
- Devoted Health
- Kaiser Permanente
- Zing Health Of Michigan, INC.
- Blue Cross Blue Shield (affiliate)
- Bluecross Blueshield Of Tennessee, INC.
- Central Health Plan Of California, INC.
- Clover Health
- Atrio Health Plans
- Mount Carmel Health Plan, INC.
- Pacificsource Community Health Plans
- Allina Health And Aetna Insurance Company
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.