Varies by plan

Does Priority Health require prior authorization for Nivestym?

Prior authorization for Nivestym differs across Priority Health's Medicare Part D plans and product strengths — 2 of 4 Nivestym 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	Status
0.5 ML filgrastim-aafi 0.6 MG/ML Prefilled Syringe [Nivestym]2057205	37 / 37	37	Prior authorization required
1 ML filgrastim-aafi 0.3 MG/ML Injection [Nivestym]2057212	0 / 37	0	Not on formulary
0.8 ML filgrastim-aafi 0.6 MG/ML Prefilled Syringe [Nivestym]2057216	37 / 37	37	Prior authorization required
1.6 ML filgrastim-aafi 0.3 MG/ML Injection [Nivestym]2057219	0 / 37	0	Not on formulary

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

Plan-by-plan detail — 0.5 ML filgrastim-aafi 0.6 MG/ML Prefilled Syringe [Nivestym]

Nivestym has 4 products in the corpus; this table is for 0.5 ML filgrastim-aafi 0.6 MG/ML Prefilled Syringe [Nivestym], 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	No
PriorityMedicare (HMO-POS)	H2320-028	5	Yes	No	No
PriorityMedicare (HMO-POS)	H2320-028	5	Yes	No	No
PriorityMedicare (HMO-POS)	H2320-028	5	Yes	No	No
PriorityMedicare (HMO-POS)	H2320-028	5	Yes	No	No
PriorityMedicare Edge (PPO)	H4875-020	5	Yes	No	No
PriorityMedicare Edge (PPO)	H4875-020	5	Yes	No	No
PriorityMedicare Edge (PPO)	H4875-020	5	Yes	No	No
PriorityMedicare Key (HMO-POS)	H2320-022	5	Yes	No	No
PriorityMedicare Key (HMO-POS)	H2320-022	5	Yes	No	No
PriorityMedicare Key (HMO-POS)	H2320-022	5	Yes	No	No
PriorityMedicare Key (HMO-POS)	H2320-022	5	Yes	No	No
PriorityMedicare Key (HMO-POS)	H2320-022	5	Yes	No	No
PriorityMedicare Merit (PPO)	H4875-016	5	Yes	No	No
PriorityMedicare Merit (PPO)	H4875-016	5	Yes	No	No
PriorityMedicare Merit (PPO)	H4875-016	5	Yes	No	No
PriorityMedicare Merit (PPO)	H4875-016	5	Yes	No	No
PriorityMedicare Merit (PPO)	H4875-016	5	Yes	No	No
PriorityMedicare Smart Savings (HMO-POS)	H2320-032	5	Yes	No	No
PriorityMedicare Smart Savings (HMO-POS)	H2320-032	5	Yes	No	No
PriorityMedicare Smart Savings (HMO-POS)	H2320-032	5	Yes	No	No
PriorityMedicare Thrive (PPO)	H4875-024	5	Yes	No	No
PriorityMedicare Thrive (PPO)	H4875-024	5	Yes	No	No
PriorityMedicare Thrive Plus (PPO)	H4875-018	5	Yes	No	No
PriorityMedicare Thrive Plus (PPO)	H4875-018	5	Yes	No	No
PriorityMedicare Thrive Plus (PPO)	H4875-018	5	Yes	No	No
PriorityMedicare Thrive Plus (PPO)	H4875-018	5	Yes	No	No
PriorityMedicare Thrive Plus (PPO)	H4875-018	5	Yes	No	No
PriorityMedicare Value (HMO-POS)	H2320-029	5	Yes	No	No
PriorityMedicare Value (HMO-POS)	H2320-029	5	Yes	No	No
PriorityMedicare Value (HMO-POS)	H2320-029	5	Yes	No	No
PriorityMedicare Value (HMO-POS)	H2320-029	5	Yes	No	No
PriorityMedicare Value (HMO-POS)	H2320-029	5	Yes	No	No
PriorityMedicare Vintage (HMO-POS)	H2320-031	5	Yes	No	No
PriorityMedicare Vital (PPO)	H4875-022	5	Yes	No	No
PriorityMedicare Vital (PPO)	H4875-022	5	Yes	No	No
PriorityMedicare Vital (PPO)	H4875-022	5	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.

Nivestym at other payers

Or see Nivestym 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.