Does Providence Health Assurance require prior authorization for Xcopri?
Providence Health Assurance does not require prior authorization for Xcopri 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 7 of 7 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 |
|---|---|---|---|---|---|
| cenobamate 50 MG Oral Tablet [Xcopri]2265701 | 7 / 7 | 0 | 7 | 7 | No prior authorization |
| cenobamate 100 MG Oral Tablet [Xcopri]2283505 | 7 / 7 | 0 | 7 | 7 | No prior authorization |
| cenobamate 150 MG Oral Tablet [Xcopri]2283509 | 7 / 7 | 0 | 7 | 7 | No prior authorization |
| cenobamate 200 MG Oral Tablet [Xcopri]2283513 | 0 / 7 | 0 | 0 | 0 | Not on formulary |
| cenobamate 25 MG Oral Tablet [Xcopri]2283527 | 0 / 7 | 0 | 0 | 0 | Not on formulary |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — cenobamate 50 MG Oral Tablet [Xcopri]
Xcopri has 5 products in the corpus; this table is for cenobamate 50 MG Oral Tablet [Xcopri], 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 | No | Yes | Yes |
| Providence Medicare Extra + Rx (HMO) | H9047-064 | 5 | No | Yes | Yes |
| Providence Medicare Extra Part B Only + Rx (HMO) | H9047-013 | 5 | No | Yes | Yes |
| Providence Medicare Pine + Rx (HMO) | H9047-063 | 5 | No | Yes | Yes |
| Providence Medicare Prime + Rx (HMO) | H9047-037 | 5 | No | Yes | Yes |
| Providence Medicare Sycamore + Rx (HMO) | H9047-066 | 5 | No | Yes | Yes |
| Providence Medicare Timber + Rx (HMO) | H9047-054 | 5 | No | Yes | 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.
Xcopri 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.