Does Providence Health Assurance require prior authorization for Iclusig?
Providence Health Assurance requires prior authorization for Iclusig 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 | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| ponatinib 15 MG Oral Tablet [Iclusig]1364358 | 7 / 7 | 7 | 0 | 7 | Prior authorization required |
| ponatinib 45 MG Oral Tablet [Iclusig]1364362 | 7 / 7 | 7 | 0 | 7 | Prior authorization required |
| ponatinib 30 MG Oral Tablet [Iclusig]1726639 | 7 / 7 | 7 | 0 | 7 | Prior authorization required |
| ponatinib 10 MG Oral Tablet [Iclusig]2473042 | 7 / 7 | 7 | 0 | 7 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — ponatinib 15 MG Oral Tablet [Iclusig]
Iclusig has 4 products in the corpus; this table is for ponatinib 15 MG Oral Tablet [Iclusig], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Providence Medicare Dual Plus (HMO D-SNP) | H9047-043 | 5 | Yes | No | Yes |
| Providence Medicare Extra + Rx (HMO) | H9047-064 | 5 | Yes | No | Yes |
| Providence Medicare Extra Part B Only + Rx (HMO) | H9047-013 | 5 | Yes | No | Yes |
| Providence Medicare Pine + Rx (HMO) | H9047-063 | 5 | Yes | No | Yes |
| Providence Medicare Prime + Rx (HMO) | H9047-037 | 5 | Yes | No | Yes |
| Providence Medicare Sycamore + Rx (HMO) | H9047-066 | 5 | Yes | No | Yes |
| Providence Medicare Timber + Rx (HMO) | H9047-054 | 5 | Yes | No | Yes |
- 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.
Iclusig 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.