Prior authorization required

Does New York Quality Healthcare Corporation require prior authorization for Eligard?

New York Quality Healthcare Corporation requires prior authorization for Eligard 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
0.375 ML leuprolide acetate 120 MG/ML Prefilled Syringe [Eligard]825325	9 / 9	9	Prior authorization required
0.5 ML leuprolide acetate 60 MG/ML Prefilled Syringe [Eligard]825333	9 / 9	9	Prior authorization required
0.25 ML leuprolide acetate 30 MG/ML Prefilled Syringe [Eligard]825334	9 / 9	9	Prior authorization required
0.375 ML leuprolide acetate 60 MG/ML Prefilled Syringe [Eligard]825335	9 / 9	9	Prior authorization required

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

Plan-by-plan detail — 0.375 ML leuprolide acetate 120 MG/ML Prefilled Syringe [Eligard]

Eligard has 4 products in the corpus; this table is for 0.375 ML leuprolide acetate 120 MG/ML Prefilled Syringe [Eligard], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
Wellcare Assist (HMO-POS)	H4868-016	3	Yes	No	No
Wellcare Dual Access (HMO D-SNP)	H4868-004	3	Yes	No	No
Wellcare Dual Access (HMO D-SNP)	H4868-014	3	Yes	No	No
Wellcare Fidelis Assist (HMO-POS)	H5599-002	3	Yes	No	No
Wellcare Fidelis Dual Align (HMO D-SNP)	H5599-003	3	Yes	No	No
Wellcare Fidelis Dual Liberty Sync (HMO D-SNP)	H5599-013	3	Yes	No	No
Wellcare Fidelis Dual Liberty Sync (HMO D-SNP)	H5599-013	3	Yes	No	No
Wellcare Fidelis Simple (HMO-POS)	H5599-004	3	Yes	No	No
Wellcare Simple (HMO-POS)	H4868-019	3	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.

Eligard at other payers

Or see Eligard 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.