Prior authorization required

Does Optimum Healthcare, INC. require prior authorization for Somavert?

Optimum Healthcare, INC. requires prior authorization for Somavert 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
pegvisomant 30 MG Injection [Somavert]1549454	15 / 15	15	Prior authorization required
pegvisomant 25 MG Injection [Somavert]1549456	15 / 15	15	Prior authorization required
pegvisomant 10 MG Injection [Somavert]404457	15 / 15	15	Prior authorization required
pegvisomant 15 MG Injection [Somavert]404458	15 / 15	15	Prior authorization required
pegvisomant 20 MG Injection [Somavert]404459	15 / 15	15	Prior authorization required

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

Plan-by-plan detail — pegvisomant 30 MG Injection [Somavert]

Somavert has 5 products in the corpus; this table is for pegvisomant 30 MG Injection [Somavert], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
Optimum Diamond (HMO C-SNP)	H5594-036	4	Yes	No	No
Optimum Diamond Rewards (HMO C-SNP)	H5594-028	4	Yes	No	No
Optimum Diamond Rewards (HMO C-SNP)	H5594-034	4	Yes	No	No
Optimum Diamond Rewards COPD (HMO C-SNP)	H5594-029	4	Yes	No	No
Optimum Diamond Rewards COPD (HMO C-SNP)	H5594-035	4	Yes	No	No
Optimum Diamond Savings (HMO C-SNP)	H5594-030	4	Yes	No	No
Optimum Diamond Savings COPD (HMO C-SNP)	H5594-031	4	Yes	No	No
Optimum Emerald Full (HMO D-SNP)	H5594-017	4	Yes	No	No
Optimum Emerald Partial (HMO D-SNP)	H5594-016	4	Yes	No	No
Optimum Gold Plan (HMO)	H5594-019	4	Yes	No	No
Optimum Gold Plus Plan (HMO)	H5594-032	4	Yes	No	No
Optimum Gold Rewards Plan (HMO)	H5594-001	4	Yes	No	No
Optimum Gold Rewards Plan (HMO)	H5594-022	4	Yes	No	No
Optimum Gold Rewards Plan (HMO)	H5594-026	4	Yes	No	No
Optimum Platinum Plan (HMO)	H5594-002	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.

Somavert at other payers

Or see Somavert 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.