Varies by plan

Does Physicians Health Choice Of Texas, LLC require prior authorization for Adempas?

Prior authorization for Adempas differs across Physicians Health Choice Of Texas, LLC's Medicare Part D plans and product strengths — 4 of 5 Adempas 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	Status
riociguat 0.5 MG Oral Tablet [Adempas]1439894	22 / 22	22	Prior authorization required
riociguat 1 MG Oral Tablet [Adempas]1439896	22 / 22	22	Prior authorization required
riociguat 1.5 MG Oral Tablet [Adempas]1439899	22 / 22	22	Prior authorization required
riociguat 2 MG Oral Tablet [Adempas]1439901	22 / 22	22	Prior authorization required
riociguat 2.5 MG Oral Tablet [Adempas]1439903	0 / 22	0	Not on formulary

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

Plan-by-plan detail — riociguat 0.5 MG Oral Tablet [Adempas]

Adempas has 5 products in the corpus; this table is for riociguat 0.5 MG Oral Tablet [Adempas], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
AARP Medicare Advantage CareFlex from UHC TX-47 (HMO-POS)	H4527-053	5	Yes	No	No
AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS)	H4527-001	5	Yes	No	No
AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS)	H4527-002	5	Yes	No	No
AARP Medicare Advantage Essentials from UHC TX-14 (HMO-POS)	H4527-013	5	Yes	No	No
AARP Medicare Advantage Extras from UHC TX-50 (HMO-POS)	H4527-055	5	Yes	No	No
AARP Medicare Advantage Extras from UHC TX-52 (HMO-POS)	H4527-056	5	Yes	No	No
AARP Medicare Advantage Extras from UHC TX-53 (HMO-POS)	H4527-059	5	Yes	No	No
AARP Medicare Advantage from UHC TX-0013 (HMO-POS)	H4527-005	5	Yes	No	No
AARP Medicare Advantage from UHC TX-0015 (HMO-POS)	H4527-037	5	Yes	No	No
AARP Medicare Advantage from UHC TX-0020 (HMO-POS)	H4527-045	5	Yes	No	No
AARP Medicare Advantage from UHC TX-46 (HMO-POS)	H4527-052	5	Yes	No	No
AARP Medicare Advantage from UHC TX-51 (HMO-POS)	H4527-058	5	Yes	No	No
AARP Medicare Advantage Giveback from UHC TX-35 (HMO-POS)	H4527-048	5	Yes	No	No
AARP Medicare Advantage Giveback from UHC TX-38 (HMO-POS)	H4527-051	5	Yes	No	No
UHC Complete Care TX-16 (HMO-POS C-SNP)	H4527-039	5	Yes	No	No
UHC Complete Care TX-17 (HMO-POS C-SNP)	H4527-040	5	Yes	No	No
UHC Complete Care TX-18 (HMO-POS C-SNP)	H4527-041	5	Yes	No	No
UHC Complete Care TX-19 (HMO-POS C-SNP)	H4527-042	5	Yes	No	No
UHC Dual Complete TX-D003 (HMO-POS D-SNP)	H4527-015	5	Yes	No	No
UHC Dual Complete TX-Q2 (HMO-POS D-SNP)	H4527-057	5	Yes	No	No
UHC Dual Complete TX-S4 (HMO-POS D-SNP)	H4527-054	5	Yes	No	No
UHC Dual Complete TX-V002 (HMO-POS D-SNP)	H4527-003	5	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.

Adempas at other payers

Or see Adempas 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.