Does Prominence Healthfirst Of Texas require prior authorization for Drizalma?
Prominence Healthfirst Of Texas does not require prior authorization for Drizalma 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 13 of 13 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 |
|---|---|---|---|---|---|
| Sprinkle duloxetine 20 MG Delayed Release Oral Capsule [Drizalma]2200174 | 13 / 13 | 0 | 13 | 13 | No prior authorization |
| Sprinkle duloxetine 30 MG Delayed Release Oral Capsule [Drizalma]2200177 | 13 / 13 | 0 | 13 | 13 | No prior authorization |
| Sprinkle duloxetine 40 MG Delayed Release Oral Capsule [Drizalma]2200180 | 13 / 13 | 0 | 13 | 13 | No prior authorization |
| Sprinkle duloxetine 60 MG Delayed Release Oral Capsule [Drizalma]2200183 | 0 / 13 | 0 | 0 | 0 | Not on formulary |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — Sprinkle duloxetine 20 MG Delayed Release Oral Capsule [Drizalma]
Drizalma has 4 products in the corpus; this table is for Sprinkle duloxetine 20 MG Delayed Release Oral Capsule [Drizalma], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Prominence Beyond (HMO-POS) | H7680-019 | 4 | No | Yes | Yes |
| Prominence Beyond (HMO) | H7680-011 | 4 | No | Yes | Yes |
| Prominence Diabetes and Heart Care Plus (HMO C-SNP) | H7680-016 | 4 | No | Yes | Yes |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | H7680-015 | 4 | No | Yes | Yes |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | H7680-020 | 4 | No | Yes | Yes |
| Prominence Dual (HMO D-SNP) | H7680-007 | 4 | No | Yes | Yes |
| Prominence Dual (HMO D-SNP) | H7680-017 | 4 | No | Yes | Yes |
| Prominence Extra Help (HMO) | H7680-009 | 4 | No | Yes | Yes |
| Prominence Extra Help (HMO) | H7680-018 | 4 | No | Yes | Yes |
| Prominence Giveback (HMO) | H7680-012 | 4 | No | Yes | Yes |
| Prominence Giveback (HMO) | H7680-014 | 4 | No | Yes | Yes |
| Prominence Plus (HMO) | H7680-001 | 4 | No | Yes | Yes |
| Prominence Plus (HMO) | H7680-002 | 4 | No | Yes | Yes |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
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Drizalma 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.