Does Optimum Healthcare, INC. require prior authorization for Xarelto?
Optimum Healthcare, INC. does not require prior authorization for Xarelto 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 |
|---|---|---|---|---|---|
| rivaroxaban 10 MG Oral Tablet [Xarelto]1114202 | 15 / 15 | 0 | 0 | 15 | No prior authorization |
| rivaroxaban 15 MG Oral Tablet [Xarelto]1232084 | 15 / 15 | 0 | 0 | 15 | No prior authorization |
| rivaroxaban 20 MG Oral Tablet [Xarelto]1232088 | 15 / 15 | 0 | 0 | 15 | No prior authorization |
| rivaroxaban 2.5 MG Oral Tablet [Xarelto]2059017 | 0 / 15 | 0 | 0 | 0 | Not on formulary |
| rivaroxaban 1 MG/ML Oral Suspension [Xarelto]2588066 | 0 / 15 | 0 | 0 | 0 | Not on formulary |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — rivaroxaban 10 MG Oral Tablet [Xarelto]
Xarelto has 5 products in the corpus; this table is for rivaroxaban 10 MG Oral Tablet [Xarelto], 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 | 2 | No | No | Yes |
| Optimum Diamond Rewards (HMO C-SNP) | H5594-028 | 2 | No | No | Yes |
| Optimum Diamond Rewards (HMO C-SNP) | H5594-034 | 2 | No | No | Yes |
| Optimum Diamond Rewards COPD (HMO C-SNP) | H5594-029 | 2 | No | No | Yes |
| Optimum Diamond Rewards COPD (HMO C-SNP) | H5594-035 | 2 | No | No | Yes |
| Optimum Diamond Savings (HMO C-SNP) | H5594-030 | 2 | No | No | Yes |
| Optimum Diamond Savings COPD (HMO C-SNP) | H5594-031 | 2 | No | No | Yes |
| Optimum Emerald Full (HMO D-SNP) | H5594-017 | 2 | No | No | Yes |
| Optimum Emerald Partial (HMO D-SNP) | H5594-016 | 2 | No | No | Yes |
| Optimum Gold Plan (HMO) | H5594-019 | 2 | No | No | Yes |
| Optimum Gold Plus Plan (HMO) | H5594-032 | 2 | No | No | Yes |
| Optimum Gold Rewards Plan (HMO) | H5594-001 | 2 | No | No | Yes |
| Optimum Gold Rewards Plan (HMO) | H5594-022 | 2 | No | No | Yes |
| Optimum Gold Rewards Plan (HMO) | H5594-026 | 2 | No | No | Yes |
| Optimum Platinum Plan (HMO) | H5594-002 | 2 | No | 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.
Xarelto 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.