Varies by plan

Does Priority Health require prior authorization for Enbrel?

Prior authorization for Enbrel differs across Priority Health's Medicare Part D plans and product strengths — 3 of 5 Enbrel 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
1 ML etanercept 50 MG/ML Auto-Injector [Enbrel]1653225	37 / 37	37	37	Prior authorization required
1 ML etanercept 50 MG/ML Cartridge [Enbrel]2182340	37 / 37	37	37	Prior authorization required
0.5 ML etanercept 50 MG/ML Injection [Enbrel]2392142	37 / 37	37	37	Prior authorization required
1 ML etanercept 50 MG/ML Prefilled Syringe [Enbrel]802652	0 / 37	0	0	Not on formulary
0.5 ML etanercept 50 MG/ML Prefilled Syringe [Enbrel]809159	0 / 37	0	0	Not on formulary

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

Plan-by-plan detail — 1 ML etanercept 50 MG/ML Auto-Injector [Enbrel]

Enbrel has 5 products in the corpus; this table is for 1 ML etanercept 50 MG/ML Auto-Injector [Enbrel], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
PriorityMedicare (HMO-POS)	H2320-028	5	Yes	No	Yes
PriorityMedicare (HMO-POS)	H2320-028	5	Yes	No	Yes
PriorityMedicare (HMO-POS)	H2320-028	5	Yes	No	Yes
PriorityMedicare (HMO-POS)	H2320-028	5	Yes	No	Yes
PriorityMedicare (HMO-POS)	H2320-028	5	Yes	No	Yes
PriorityMedicare Edge (PPO)	H4875-020	5	Yes	No	Yes
PriorityMedicare Edge (PPO)	H4875-020	5	Yes	No	Yes
PriorityMedicare Edge (PPO)	H4875-020	5	Yes	No	Yes
PriorityMedicare Key (HMO-POS)	H2320-022	5	Yes	No	Yes
PriorityMedicare Key (HMO-POS)	H2320-022	5	Yes	No	Yes
PriorityMedicare Key (HMO-POS)	H2320-022	5	Yes	No	Yes
PriorityMedicare Key (HMO-POS)	H2320-022	5	Yes	No	Yes
PriorityMedicare Key (HMO-POS)	H2320-022	5	Yes	No	Yes
PriorityMedicare Merit (PPO)	H4875-016	5	Yes	No	Yes
PriorityMedicare Merit (PPO)	H4875-016	5	Yes	No	Yes
PriorityMedicare Merit (PPO)	H4875-016	5	Yes	No	Yes
PriorityMedicare Merit (PPO)	H4875-016	5	Yes	No	Yes
PriorityMedicare Merit (PPO)	H4875-016	5	Yes	No	Yes
PriorityMedicare Smart Savings (HMO-POS)	H2320-032	5	Yes	No	Yes
PriorityMedicare Smart Savings (HMO-POS)	H2320-032	5	Yes	No	Yes
PriorityMedicare Smart Savings (HMO-POS)	H2320-032	5	Yes	No	Yes
PriorityMedicare Thrive (PPO)	H4875-024	5	Yes	No	Yes
PriorityMedicare Thrive (PPO)	H4875-024	5	Yes	No	Yes
PriorityMedicare Thrive Plus (PPO)	H4875-018	5	Yes	No	Yes
PriorityMedicare Thrive Plus (PPO)	H4875-018	5	Yes	No	Yes
PriorityMedicare Thrive Plus (PPO)	H4875-018	5	Yes	No	Yes
PriorityMedicare Thrive Plus (PPO)	H4875-018	5	Yes	No	Yes
PriorityMedicare Thrive Plus (PPO)	H4875-018	5	Yes	No	Yes
PriorityMedicare Value (HMO-POS)	H2320-029	5	Yes	No	Yes
PriorityMedicare Value (HMO-POS)	H2320-029	5	Yes	No	Yes
PriorityMedicare Value (HMO-POS)	H2320-029	5	Yes	No	Yes
PriorityMedicare Value (HMO-POS)	H2320-029	5	Yes	No	Yes
PriorityMedicare Value (HMO-POS)	H2320-029	5	Yes	No	Yes
PriorityMedicare Vintage (HMO-POS)	H2320-031	5	Yes	No	Yes
PriorityMedicare Vital (PPO)	H4875-022	5	Yes	No	Yes
PriorityMedicare Vital (PPO)	H4875-022	5	Yes	No	Yes
PriorityMedicare Vital (PPO)	H4875-022	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.

Enbrel at other payers

Or see Enbrel 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.