Varies by plan

Does Pacificsource Community Health Plans require prior authorization for Pyzchiva?

Prior authorization for Pyzchiva differs across Pacificsource Community Health Plans's Medicare Part D plans and product strengths — 3 of 5 Pyzchiva products in the corpus appear on their formularies, and the requirement is not uniform. Check the member's specific plan.

Some plans require authorization and others do not. The member's specific plan decides.

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	Qty limit	Status
0.5 ML ustekinumab-ttwe 90 MG/ML Prefilled Syringe [Pyzchiva]2705573	11 / 11	11	11	Prior authorization required
1 ML ustekinumab-ttwe 90 MG/ML Prefilled Syringe [Pyzchiva]2705576	11 / 11	11	11	Prior authorization required
0.5 ML ustekinumab-ttwe 90 MG/ML Injection [Pyzchiva]2713887	11 / 11	11	11	Prior authorization required
0.5 ML ustekinumab-ttwe 90 MG/ML Auto-Injector [Pyzchiva]2720516	0 / 11	0	0	Not on formulary
1 ML ustekinumab-ttwe 90 MG/ML Auto-Injector [Pyzchiva]2721431	0 / 11	0	0	Not on formulary

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

Plan-by-plan detail — 0.5 ML ustekinumab-ttwe 90 MG/ML Prefilled Syringe [Pyzchiva]

Pyzchiva has 5 products in the corpus; this table is for 0.5 ML ustekinumab-ttwe 90 MG/ML Prefilled Syringe [Pyzchiva], 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	4	Yes	No	Yes
PacificSource Medicare Essentials Choice Rx 14 (HMO-POS)	H3864-014	4	Yes	No	Yes
PacificSource Medicare Essentials Choice Rx 36 (HMO-POS)	H3864-036	4	Yes	No	Yes
PacificSource Medicare Essentials Rx 27 (HMO)	H3864-027	4	Yes	No	Yes
PacificSource Medicare Essentials Rx 41 (HMO)	H3864-041	4	Yes	No	Yes
PacificSource Medicare Essentials Rx 6 (HMO)	H3864-006	4	Yes	No	Yes
PacificSource Medicare Explorer Rx 4 (PPO)	H4754-004	4	Yes	No	Yes
PacificSource Medicare MyCare Choice Rx 24 (HMO-POS)	H3864-024	4	Yes	No	Yes
PacificSource Medicare MyCare Choice Rx 29 (HMO-POS)	H3864-029	4	Yes	No	Yes
PacificSource Medicare MyCare Choice Rx 34 (HMO-POS)	H3864-034	4	Yes	No	Yes
PacificSource Medicare MyCare Rx 40 (HMO)	H3864-040	4	Yes	No	Yes

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.

Pyzchiva at other payers

Or see Pyzchiva 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.