Varies by plan

Does Molina Healthcare require prior authorization for Lupron?

Prior authorization for Lupron differs across Molina Healthcare's Medicare Part D plans and product strengths — 2 of 9 Lupron 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	Status
1.5 ML leuprolide acetate 30 MG/ML Prefilled Syringe [Lupron]1115259	0 / 51	0	Not on formulary
1 ML leuprolide acetate 3.75 MG/ML Prefilled Syringe [Lupron]1115459	51 / 51	51	Prior authorization required
1 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron]1115464	0 / 51	0	Not on formulary
1.5 ML leuprolide acetate 15 MG/ML Prefilled Syringe [Lupron]1115468	0 / 51	0	Not on formulary
1.5 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron]1115473	51 / 51	51	Prior authorization required
4-Month 1.5 ML leuprolide acetate 20 MG/ML Prefilled Syringe [Lupron]1946522	0 / 51	0	Not on formulary
Pediatric 1.5 ML leuprolide acetate 30 MG/ML Prefilled Syringe [Lupron]2639669	0 / 51	0	Not on formulary
Pediatric 1 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron]2639743	0 / 51	0	Not on formulary
Pediatric 1.5 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron]2639750	0 / 51	0	Not on formulary

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

Plan-by-plan detail — 1 ML leuprolide acetate 3.75 MG/ML Prefilled Syringe [Lupron]

Lupron has 9 products in the corpus; this table is for 1 ML leuprolide acetate 3.75 MG/ML Prefilled Syringe [Lupron], 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	No
Molina Dual MI Coordinated Health (HMO D-SNP)	H5926-008	5	Yes	No	No
Molina Dual MI Coordinated Health (HMO D-SNP)	H5926-009	5	Yes	No	No
Molina Medicare Choice Care (HMO)	H2715-003	5	Yes	No	No
Molina Medicare Choice Care (HMO)	H5810-014	5	Yes	No	No
Molina Medicare Complete Care (HMO D-SNP)	H1799-004	5	Yes	No	No
Molina Medicare Complete Care (HMO D-SNP)	H1799-005	5	Yes	No	No
Molina Medicare Complete Care (HMO D-SNP)	H2478-001	5	Yes	No	No
Molina Medicare Complete Care (HMO D-SNP)	H2715-006	5	Yes	No	No
Molina Medicare Complete Care (HMO D-SNP)	H2715-006	5	Yes	No	No
Molina Medicare Complete Care (HMO D-SNP)	H5628-001	5	Yes	No	No
Molina Medicare Complete Care (HMO D-SNP)	H5628-013	5	Yes	No	No
Molina Medicare Complete Care (HMO D-SNP)	H5628-013	5	Yes	No	No
Molina Medicare Complete Care (HMO D-SNP)	H5823-013	5	Yes	No	No
Molina Medicare Complete Care (HMO D-SNP)	H5823-013	5	Yes	No	No
Molina Medicare Complete Care (HMO D-SNP)	H5926-001	5	Yes	No	No
Molina Medicare Complete Care (HMO D-SNP)	H7678-006	5	Yes	No	No
Molina Medicare Complete Care (HMO D-SNP)	H7678-006	5	Yes	No	No
Molina Medicare Complete Care (HMO D-SNP)	H8845-001	5	Yes	No	No
Molina Medicare Complete Care (HMO D-SNP)	H8845-004	5	Yes	No	No
Molina Medicare Complete Care (HMO D-SNP)	H8845-005	5	Yes	No	No
Molina Medicare Complete Care (HMO D-SNP)	H8845-007	5	Yes	No	No
Molina Medicare Complete Care (HMO D-SNP)	H8845-007	5	Yes	No	No
Molina Medicare Complete Care (HMO D-SNP)	H9955-007	5	Yes	No	No
Molina Medicare Complete Care Plus (HMO D-SNP)	H3038-004	5	Yes	No	No
Molina Medicare Complete Care Plus (HMO D-SNP)	H3038-004	5	Yes	No	No
Molina Medicare Complete Care Plus (HMO D-SNP)	H3038-004	5	Yes	No	No
Molina Medicare Complete Care Plus (HMO D-SNP)	H3038-004	5	Yes	No	No
Molina Medicare Complete Care Plus (HMO D-SNP)	H3093-001	5	Yes	No	No
Molina Medicare Complete Care Plus (HMO D-SNP)	H3093-002	5	Yes	No	No
Molina Medicare Complete Care Plus (HMO D-SNP)	H3093-003	5	Yes	No	No
Molina Medicare Complete Care Plus (HMO D-SNP)	H3093-004	5	Yes	No	No
Molina Medicare Complete Care Plus (HMO D-SNP)	H3093-005	5	Yes	No	No
Molina Medicare Complete Care Plus (HMO D-SNP)	H6515-001	5	Yes	No	No
Molina Medicare Complete Care Plus (HMO D-SNP)	H6515-002	5	Yes	No	No
Molina Medicare Complete Care Plus (HMO D-SNP)	H6515-003	5	Yes	No	No
Molina Medicare Complete Care Plus (HMO D-SNP)	H6515-004	5	Yes	No	No
Molina Medicare Complete Care Plus (HMO D-SNP)	H6515-005	5	Yes	No	No
Molina Medicare Complete Care Plus (HMO D-SNP)	H8176-004	5	Yes	No	No
Molina Medicare Complete Care Plus (HMO D-SNP)	H8176-004	5	Yes	No	No
Molina Medicare Complete Care Select (HMO D-SNP)	H5628-012	5	Yes	No	No
Molina Medicare Complete Care Select (HMO D-SNP)	H5628-014	5	Yes	No	No
Molina Medicare Complete Care Select (HMO D-SNP)	H5628-014	5	Yes	No	No
Molina Medicare Complete Care Select (HMO D-SNP)	H5823-010	5	Yes	No	No
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)	H5209-006	5	Yes	No	No
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)	H5209-006	5	Yes	No	No
My Choice Wisconsin Partnership Plan (HMO D-SNP)	H5209-005	5	Yes	No	No
My Choice Wisconsin Partnership Plan (HMO D-SNP)	H5209-005	5	Yes	No	No
Passport Advantage (HMO D-SNP)	H1799-003	5	Yes	No	No
Passport Advantage (HMO D-SNP)	H1799-003	5	Yes	No	No
Passport Advantage (HMO D-SNP)	H1799-003	5	Yes	No	No

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.

Lupron at other payers

Or see Lupron 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.