Does Pacificsource Community Health Plans require prior authorization for Fyavolv?
Pacificsource Community Health Plans does not require prior authorization for Fyavolv on the Medicare Part D plans that cover it.
No covering plan from this payer files a prior-authorization requirement for this drug.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| ethinyl estradiol 0.0025 MG / norethindrone acetate 0.5 MG Oral Tablet [Fyavolv]1736654 | 11 / 11 | 0 | 0 | 0 | No prior authorization |
| ethinyl estradiol 0.005 MG / norethindrone acetate 1 MG Oral Tablet [Fyavolv]1736656 | 11 / 11 | 0 | 0 | 0 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — ethinyl estradiol 0.0025 MG / norethindrone acetate 0.5 MG Oral Tablet [Fyavolv]
Fyavolv has 2 products in the corpus; this table is for ethinyl estradiol 0.0025 MG / norethindrone acetate 0.5 MG Oral Tablet [Fyavolv], 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 | 2 | No | No | No |
| PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) | H3864-014 | 2 | No | No | No |
| PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) | H3864-036 | 2 | No | No | No |
| PacificSource Medicare Essentials Rx 27 (HMO) | H3864-027 | 2 | No | No | No |
| PacificSource Medicare Essentials Rx 41 (HMO) | H3864-041 | 2 | No | No | No |
| PacificSource Medicare Essentials Rx 6 (HMO) | H3864-006 | 2 | No | No | No |
| PacificSource Medicare Explorer Rx 4 (PPO) | H4754-004 | 2 | No | No | No |
| PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) | H3864-024 | 2 | No | No | No |
| PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) | H3864-029 | 2 | No | No | No |
| PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) | H3864-034 | 2 | No | No | No |
| PacificSource Medicare MyCare Rx 40 (HMO) | H3864-040 | 2 | No | No | No |
- 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.
Fyavolv 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.