Prior authorization required

Does Pacificsource Community Health Plans require prior authorization for Cystagon?

Pacificsource Community Health Plans requires prior authorization for Cystagon 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	Step therapy	Qty limit	Status
cysteamine 150 MG Oral Capsule [Cystagon]209788	11 / 11	11	0	0	Prior authorization required
cysteamine 50 MG Oral Capsule [Cystagon]209789	11 / 11	11	0	0	Prior authorization required

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

Plan-by-plan detail — cysteamine 150 MG Oral Capsule [Cystagon]

Cystagon has 2 products in the corpus; this table is for cysteamine 150 MG Oral Capsule [Cystagon], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
PacificSource Dual Care (HMO D-SNP)	H3864-043	3	Yes	No	No
PacificSource Medicare Essentials Choice Rx 14 (HMO-POS)	H3864-014	3	Yes	No	No
PacificSource Medicare Essentials Choice Rx 36 (HMO-POS)	H3864-036	3	Yes	No	No
PacificSource Medicare Essentials Rx 27 (HMO)	H3864-027	3	Yes	No	No
PacificSource Medicare Essentials Rx 41 (HMO)	H3864-041	3	Yes	No	No
PacificSource Medicare Essentials Rx 6 (HMO)	H3864-006	3	Yes	No	No
PacificSource Medicare Explorer Rx 4 (PPO)	H4754-004	3	Yes	No	No
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS)	H3864-024	3	Yes	No	No
PacificSource Medicare MyCare Choice Rx 29 (HMO-POS)	H3864-029	3	Yes	No	No
PacificSource Medicare MyCare Choice Rx 34 (HMO-POS)	H3864-034	3	Yes	No	No
PacificSource Medicare MyCare Rx 40 (HMO)	H3864-040	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.

Cystagon at other payers

Or see Cystagon 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.