Does Mount Carmel Health Plan, INC. require prior authorization for Fyavolv?
Mount Carmel Health Plan, INC. does not require prior authorization for Fyavolv 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 |
|---|---|---|---|---|---|
| ethinyl estradiol 0.0025 MG / norethindrone acetate 0.5 MG Oral Tablet [Fyavolv]1736654 | 11 / 11 | 0 | 0 | 0 | No prior authorization |
| ethinyl estradiol 0.005 MG / norethindrone acetate 1 MG Oral Tablet [Fyavolv]1736656 | 11 / 11 | 0 | 0 | 0 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — ethinyl estradiol 0.0025 MG / norethindrone acetate 0.5 MG Oral Tablet [Fyavolv]
Fyavolv has 2 products in the corpus; this table is for ethinyl estradiol 0.0025 MG / norethindrone acetate 0.5 MG Oral Tablet [Fyavolv], 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 | 3 | No | No | No |
| MercyOne Health Plan No Premium (HMO) | H3668-025 | 3 | No | No | No |
| MercyOne Health Plan Plus (HMO) | H3668-026 | 3 | No | No | No |
| Mount Carmel MediGold Cash Back (HMO) | H3668-030 | 3 | No | No | No |
| Mount Carmel MediGold No Premium (HMO) | H3668-019 | 3 | No | No | No |
| Mount Carmel MediGold No Premium (HMO) | H3668-019 | 3 | No | No | No |
| Mount Carmel MediGold No Premium (HMO) | H3668-020 | 3 | No | No | No |
| Mount Carmel MediGold Plus (HMO) | H3668-022 | 3 | No | No | No |
| Mount Carmel MediGold Plus (HMO) | H3668-023 | 3 | No | No | No |
| Mount Carmel MediGold Premier (HMO) | H3668-018 | 3 | No | No | No |
| Mount Carmel MediGold Premier (HMO) | H3668-018 | 3 | No | No | No |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
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Fyavolv 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.