Prior authorization required

Does Mount Carmel Health Plan, INC. require prior authorization for Claravis?

Mount Carmel Health Plan, INC. requires prior authorization for Claravis 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	Status
isotretinoin 10 MG Oral Capsule [Claravis]404059	11 / 11	11	Prior authorization required
isotretinoin 20 MG Oral Capsule [Claravis]404062	11 / 11	11	Prior authorization required
isotretinoin 40 MG Oral Capsule [Claravis]404065	11 / 11	11	Prior authorization required
isotretinoin 30 MG Oral Capsule [Claravis]643488	11 / 11	11	Prior authorization required

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

Plan-by-plan detail — isotretinoin 10 MG Oral Capsule [Claravis]

Claravis has 4 products in the corpus; this table is for isotretinoin 10 MG Oral Capsule [Claravis], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
MercyOne Health Plan Cash Back (HMO)	H3668-031	4	Yes	No	No
MercyOne Health Plan No Premium (HMO)	H3668-025	4	Yes	No	No
MercyOne Health Plan Plus (HMO)	H3668-026	4	Yes	No	No
Mount Carmel MediGold Cash Back (HMO)	H3668-030	4	Yes	No	No
Mount Carmel MediGold No Premium (HMO)	H3668-019	4	Yes	No	No
Mount Carmel MediGold No Premium (HMO)	H3668-019	4	Yes	No	No
Mount Carmel MediGold No Premium (HMO)	H3668-020	4	Yes	No	No
Mount Carmel MediGold Plus (HMO)	H3668-022	4	Yes	No	No
Mount Carmel MediGold Plus (HMO)	H3668-023	4	Yes	No	No
Mount Carmel MediGold Premier (HMO)	H3668-018	4	Yes	No	No
Mount Carmel MediGold Premier (HMO)	H3668-018	4	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.

Claravis at other payers

Or see Claravis 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.