Benefily
No prior authorization

Does Priority Health require prior authorization for Intelence?

Priority Health does not require prior authorization for Intelence on the Medicare Part D plans that cover it.

No covering plan from this payer files a prior-authorization requirement for this drug.

  • 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 productPlans coveringRequire prior authStep therapyQty limitStatus
etravirine 200 MG Oral Tablet [Intelence]10526600 / 37000Not on formulary
etravirine 25 MG Oral Tablet [Intelence]125072337 / 370037No prior authorization
etravirine 100 MG Oral Tablet [Intelence]7585550 / 37000Not on formulary

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

Plan-by-plan detail — etravirine 25 MG Oral Tablet [Intelence]

Intelence has 3 products in the corpus; this table is for etravirine 25 MG Oral Tablet [Intelence], the one carried on the most plans. The product table above covers every strength.

PlanContractTierPrior authStep therapyQty limit
PriorityMedicare (HMO-POS)H2320-0283NoNoYes
PriorityMedicare (HMO-POS)H2320-0283NoNoYes
PriorityMedicare (HMO-POS)H2320-0283NoNoYes
PriorityMedicare (HMO-POS)H2320-0283NoNoYes
PriorityMedicare (HMO-POS)H2320-0283NoNoYes
PriorityMedicare Edge (PPO)H4875-0203NoNoYes
PriorityMedicare Edge (PPO)H4875-0203NoNoYes
PriorityMedicare Edge (PPO)H4875-0203NoNoYes
PriorityMedicare Key (HMO-POS)H2320-0223NoNoYes
PriorityMedicare Key (HMO-POS)H2320-0223NoNoYes
PriorityMedicare Key (HMO-POS)H2320-0223NoNoYes
PriorityMedicare Key (HMO-POS)H2320-0223NoNoYes
PriorityMedicare Key (HMO-POS)H2320-0223NoNoYes
PriorityMedicare Merit (PPO)H4875-0163NoNoYes
PriorityMedicare Merit (PPO)H4875-0163NoNoYes
PriorityMedicare Merit (PPO)H4875-0163NoNoYes
PriorityMedicare Merit (PPO)H4875-0163NoNoYes
PriorityMedicare Merit (PPO)H4875-0163NoNoYes
PriorityMedicare Smart Savings (HMO-POS)H2320-0323NoNoYes
PriorityMedicare Smart Savings (HMO-POS)H2320-0323NoNoYes
PriorityMedicare Smart Savings (HMO-POS)H2320-0323NoNoYes
PriorityMedicare Thrive (PPO)H4875-0243NoNoYes
PriorityMedicare Thrive (PPO)H4875-0243NoNoYes
PriorityMedicare Thrive Plus (PPO)H4875-0183NoNoYes
PriorityMedicare Thrive Plus (PPO)H4875-0183NoNoYes
PriorityMedicare Thrive Plus (PPO)H4875-0183NoNoYes
PriorityMedicare Thrive Plus (PPO)H4875-0183NoNoYes
PriorityMedicare Thrive Plus (PPO)H4875-0183NoNoYes
PriorityMedicare Value (HMO-POS)H2320-0293NoNoYes
PriorityMedicare Value (HMO-POS)H2320-0293NoNoYes
PriorityMedicare Value (HMO-POS)H2320-0293NoNoYes
PriorityMedicare Value (HMO-POS)H2320-0293NoNoYes
PriorityMedicare Value (HMO-POS)H2320-0293NoNoYes
PriorityMedicare Vintage (HMO-POS)H2320-0313NoNoYes
PriorityMedicare Vital (PPO)H4875-0223NoNoYes
PriorityMedicare Vital (PPO)H4875-0223NoNoYes
PriorityMedicare Vital (PPO)H4875-0223NoNoYes
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.

Intelence at other payers

Or see Intelence 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.