Does Presbyterian Health Plan require prior authorization for Diacomit?
Presbyterian Health Plan does not require prior authorization for Diacomit on the Medicare Part D plans that cover it.
No covering plan from this payer files a prior-authorization requirement for this drug.
- No prior authorization is filed, but step therapy applies on 6 of 6 covering plans — the plan requires another drug be tried first.
- 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 | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| stiripentol 250 MG Oral Capsule [Diacomit]2054979 | 6 / 6 | 0 | 6 | 0 | No prior authorization |
| stiripentol 500 MG Oral Capsule [Diacomit]2054983 | 6 / 6 | 0 | 6 | 0 | No prior authorization |
| stiripentol 500 MG Powder for Oral Suspension [Diacomit]2055014 | 6 / 6 | 0 | 6 | 0 | No prior authorization |
| stiripentol 250 MG Powder for Oral Suspension [Diacomit]2055016 | 0 / 6 | 0 | 0 | 0 | Not on formulary |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — stiripentol 250 MG Oral Capsule [Diacomit]
Diacomit has 4 products in the corpus; this table is for stiripentol 250 MG Oral Capsule [Diacomit], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Presbyterian Dual Plus (HMO D-SNP) | H3204-013 | 5 | No | Yes | No |
| Presbyterian Dual Plus (HMO D-SNP) | H3204-013 | 5 | No | Yes | No |
| Presbyterian Dual Plus (HMO D-SNP) | H3204-013 | 5 | No | Yes | No |
| Presbyterian Senior Care Extra Health Plan with Rx (HMO) | H3204-017 | 5 | No | Yes | No |
| Presbyterian Senior Care Plan 2 with Rx (HMO) | H3204-001 | 5 | No | Yes | No |
| Presbyterian Senior Care Plan 3 with Rx (HMO) | H3204-007 | 5 | No | Yes | No |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
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Diacomit 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.