Prior authorization required

Does Preferred Care Partners, INC. require prior authorization for Vizimpro?

Preferred Care Partners, INC. requires prior authorization for Vizimpro 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	Qty limit	Status
dacomitinib 15 MG Oral Tablet [Vizimpro]2058922	35 / 35	35	35	Prior authorization required
dacomitinib 30 MG Oral Tablet [Vizimpro]2058926	35 / 35	35	35	Prior authorization required
dacomitinib 45 MG Oral Tablet [Vizimpro]2058932	35 / 35	35	35	Prior authorization required

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

Plan-by-plan detail — dacomitinib 15 MG Oral Tablet [Vizimpro]

Vizimpro has 3 products in the corpus; this table is for dacomitinib 15 MG Oral Tablet [Vizimpro], 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 FL-32 (HMO-POS)	H1045-057	5	Yes	No	Yes
AARP Medicare Advantage CareFlex from UHC FL-33 (HMO-POS)	H1045-058	5	Yes	No	Yes
AARP Medicare Advantage CareFlex from UHC FL-34 (HMO-POS)	H1045-059	5	Yes	No	Yes
AARP Medicare Advantage CareFlex from UHC FL-35 (HMO-POS)	H1045-060	5	Yes	No	Yes
AARP Medicare Advantage CareFlex from UHC FL-37 (HMO-POS)	H1045-067	5	Yes	No	Yes
AARP Medicare Advantage CareFlex from UHC FL-39 (HMO-POS)	H1045-069	5	Yes	No	Yes
AARP Medicare Advantage from UHC FL-0005 (HMO-POS)	H1045-026	5	Yes	No	Yes
AARP Medicare Advantage from UHC FL-0006 (HMO-POS)	H1045-028	5	Yes	No	Yes
AARP Medicare Advantage from UHC FL-0007 (HMO-POS)	H1045-030	5	Yes	No	Yes
AARP Medicare Advantage from UHC FL-0008 (HMO-POS)	H1045-031	5	Yes	No	Yes
AARP Medicare Advantage from UHC FL-0009 (HMO-POS)	H1045-033	5	Yes	No	Yes
AARP Medicare Advantage from UHC FL-0010 (HMO-POS)	H1045-034	5	Yes	No	Yes
AARP Medicare Advantage from UHC FL-0011 (HMO-POS)	H1045-041	5	Yes	No	Yes
AARP Medicare Advantage from UHC FL-0012 (HMO-POS)	H1045-042	5	Yes	No	Yes
AARP Medicare Advantage from UHC FL-0013 (HMO-POS)	H1045-043	5	Yes	No	Yes
AARP Medicare Advantage from UHC FL-0015 (HMO-POS)	H1045-055	5	Yes	No	Yes
AARP Medicare Advantage from UHC FL-001P (HMO-POS)	H1045-036	5	Yes	No	Yes
AARP Medicare Advantage from UHC FL-003P (HMO-POS)	H1045-045	5	Yes	No	Yes
UHC Complete Care FL-14 (HMO-POS C-SNP)	H1045-048	5	Yes	No	Yes
UHC Complete Care FL-14 (HMO-POS C-SNP)	H1045-048	5	Yes	No	Yes
UHC Complete Care FL-14 (HMO-POS C-SNP)	H1045-048	5	Yes	No	Yes
UHC Complete Care FL-14 (HMO-POS C-SNP)	H1045-048	5	Yes	No	Yes
UHC Dual Complete FL-D002 (HMO-POS D-SNP)	H1045-039	5	Yes	No	Yes
UHC Preferred Complete Care FL-0003 (HMO C-SNP)	H1045-018	5	Yes	No	Yes
UHC Preferred Dual Complete FL-D001 (HMO D-SNP)	H1045-012	5	Yes	No	Yes
UHC Preferred Dual Complete FL-D01P (HMO D-SNP)	H1045-038	5	Yes	No	Yes
UHC Preferred Dual Complete FL-V1 (HMO D-SNP)	H1045-061	5	Yes	No	Yes
UHC Preferred Dual Complete FL-V2 (HMO D-SNP)	H1045-064	5	Yes	No	Yes
UHC Preferred Dual Complete FL-Y2 (HMO-POS D-SNP)	H1045-063	5	Yes	No	Yes
UHC Preferred Dual Complete FL-Y3 (HMO-POS D-SNP)	H1045-065	5	Yes	No	Yes
UHC Preferred Medicare Advantage FL-0001 (HMO)	H1045-001	5	Yes	No	Yes
UHC Preferred Medicare Advantage FL-0002 (HMO)	H1045-005	5	Yes	No	Yes
UHC Preferred Medicare Advantage FL-002P (HMO)	H1045-037	5	Yes	No	Yes
UHC The Villages Medicare Advantage FL-0004 (HMO-POS)	H1045-025	5	Yes	No	Yes
UHC The Villages Medicare Advantage FL-004P (HMO-POS)	H1045-056	5	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.

Vizimpro at other payers

Or see Vizimpro 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.