Does Network Health Insurance Corporation require prior authorization for Kalydeco?
Prior authorization for Kalydeco differs across Network Health Insurance Corporation's Medicare Part D plans and product strengths — 4 of 6 Kalydeco 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 | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| ivacaftor 150 MG Oral Tablet [Kalydeco]1243052 | 8 / 8 | 8 | 0 | 8 | Prior authorization required |
| ivacaftor 50 MG Oral Granules [Kalydeco]1606866 | 8 / 8 | 8 | 0 | 8 | Prior authorization required |
| ivacaftor 75 MG Oral Granules [Kalydeco]1606870 | 8 / 8 | 8 | 0 | 8 | Prior authorization required |
| ivacaftor 25 MG Oral Granules [Kalydeco]2166401 | 8 / 8 | 8 | 0 | 8 | Prior authorization required |
| ivacaftor 13.4 MG Oral Granules [Kalydeco]2636789 | 0 / 8 | 0 | 0 | 0 | Not on formulary |
| ivacaftor 5.8 MG Oral Granules [Kalydeco]2636793 | 0 / 8 | 0 | 0 | 0 | Not on formulary |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — ivacaftor 150 MG Oral Tablet [Kalydeco]
Kalydeco has 6 products in the corpus; this table is for ivacaftor 150 MG Oral Tablet [Kalydeco], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Network Health Anywhere (PPO) | H5215-010 | 5 | Yes | No | Yes |
| Network Health Cares (PPO D-SNP) | H5215-007 | 5 | Yes | No | Yes |
| Network Health Choice (PPO) | H5215-011 | 5 | Yes | No | Yes |
| Network Health Go (PPO) | H5215-009 | 5 | Yes | No | Yes |
| Network Health PlusRx (PPO) | H5215-002 | 5 | Yes | No | Yes |
| Network Health PremierRx (PPO) | H5215-005 | 5 | Yes | No | Yes |
| Network Health Select (PPO) | H5215-008 | 5 | Yes | No | Yes |
| Network Health Zero (PPO) | H5215-012 | 5 | Yes | No | Yes |
- 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.
Kalydeco 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.