Prior authorization required

Does Pacificsource Community Health Plans require prior authorization for Gengraf?

Pacificsource Community Health Plans requires prior authorization for Gengraf 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
cyclosporine, modified 100 MG Oral Capsule [Gengraf]835835	11 / 11	11	0	0	Prior authorization required
cyclosporine, modified 25 MG Oral Capsule [Gengraf]835896	11 / 11	11	0	0	Prior authorization required

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

Plan-by-plan detail — cyclosporine, modified 100 MG Oral Capsule [Gengraf]

Gengraf has 2 products in the corpus; this table is for cyclosporine, modified 100 MG Oral Capsule [Gengraf], 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	Yes	No	No
PacificSource Medicare Essentials Choice Rx 14 (HMO-POS)	H3864-014	2	Yes	No	No
PacificSource Medicare Essentials Choice Rx 36 (HMO-POS)	H3864-036	2	Yes	No	No
PacificSource Medicare Essentials Rx 27 (HMO)	H3864-027	2	Yes	No	No
PacificSource Medicare Essentials Rx 41 (HMO)	H3864-041	2	Yes	No	No
PacificSource Medicare Essentials Rx 6 (HMO)	H3864-006	2	Yes	No	No
PacificSource Medicare Explorer Rx 4 (PPO)	H4754-004	2	Yes	No	No
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS)	H3864-024	2	Yes	No	No
PacificSource Medicare MyCare Choice Rx 29 (HMO-POS)	H3864-029	2	Yes	No	No
PacificSource Medicare MyCare Choice Rx 34 (HMO-POS)	H3864-034	2	Yes	No	No
PacificSource Medicare MyCare Rx 40 (HMO)	H3864-040	2	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.

Gengraf at other payers

Or see Gengraf 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.