Prior authorization required

Does Presbyterian Health Plan require prior authorization for Lyllana?

Presbyterian Health Plan requires prior authorization for Lyllana 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	Status
84 HR estradiol 0.00104 MG/HR Transdermal System [Lyllana]2399892	6 / 6	6	Prior authorization required
84 HR estradiol 0.00156 MG/HR Transdermal System [Lyllana]2399895	6 / 6	6	Prior authorization required
84 HR estradiol 0.00208 MG/HR Transdermal System [Lyllana]2399898	6 / 6	6	Prior authorization required
84 HR estradiol 0.00313 MG/HR Transdermal System [Lyllana]2399901	6 / 6	6	Prior authorization required
84 HR estradiol 0.00417 MG/HR Transdermal System [Lyllana]2399904	6 / 6	6	Prior authorization required

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

Plan-by-plan detail — 84 HR estradiol 0.00104 MG/HR Transdermal System [Lyllana]

Lyllana has 5 products in the corpus; this table is for 84 HR estradiol 0.00104 MG/HR Transdermal System [Lyllana], 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	3	Yes	No	No
Presbyterian Dual Plus (HMO D-SNP)	H3204-013	3	Yes	No	No
Presbyterian Dual Plus (HMO D-SNP)	H3204-013	3	Yes	No	No
Presbyterian Senior Care Extra Health Plan with Rx (HMO)	H3204-017	3	Yes	No	No
Presbyterian Senior Care Plan 2 with Rx (HMO)	H3204-001	3	Yes	No	No
Presbyterian Senior Care Plan 3 with Rx (HMO)	H3204-007	3	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.

Lyllana at other payers

Or see Lyllana 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.