Does Mount Carmel Health Plan, INC. require prior authorization for Intelence?
Mount Carmel Health Plan, INC. does not require prior authorization for Intelence on the Medicare Part D plans that cover it.
No covering plan from this payer files a prior-authorization requirement for this drug.
- 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 | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| etravirine 200 MG Oral Tablet [Intelence]1052660 | 0 / 11 | 0 | 0 | 0 | Not on formulary |
| etravirine 25 MG Oral Tablet [Intelence]1250723 | 11 / 11 | 0 | 0 | 0 | No prior authorization |
| etravirine 100 MG Oral Tablet [Intelence]758555 | 0 / 11 | 0 | 0 | 0 | Not on formulary |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — etravirine 25 MG Oral Tablet [Intelence]
Intelence has 3 products in the corpus; this table is for etravirine 25 MG Oral Tablet [Intelence], 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 | No | No | No |
| MercyOne Health Plan No Premium (HMO) | H3668-025 | 4 | No | No | No |
| MercyOne Health Plan Plus (HMO) | H3668-026 | 4 | No | No | No |
| Mount Carmel MediGold Cash Back (HMO) | H3668-030 | 4 | No | No | No |
| Mount Carmel MediGold No Premium (HMO) | H3668-019 | 4 | No | No | No |
| Mount Carmel MediGold No Premium (HMO) | H3668-019 | 4 | No | No | No |
| Mount Carmel MediGold No Premium (HMO) | H3668-020 | 4 | No | No | No |
| Mount Carmel MediGold Plus (HMO) | H3668-022 | 4 | No | No | No |
| Mount Carmel MediGold Plus (HMO) | H3668-023 | 4 | No | No | No |
| Mount Carmel MediGold Premier (HMO) | H3668-018 | 4 | No | No | No |
| Mount Carmel MediGold Premier (HMO) | H3668-018 | 4 | No | No | No |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
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Intelence 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.