Prior authorization required

Does Sanford Health Plan require prior authorization for Scemblix?

Sanford Health Plan requires prior authorization for Scemblix 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	Qty limit	Status
asciminib 20 MG Oral Tablet [Scemblix]2584326	9 / 9	9	9	Prior authorization required
asciminib 40 MG Oral Tablet [Scemblix]2584330	9 / 9	9	9	Prior authorization required
asciminib 100 MG Oral Tablet [Scemblix]2680280	9 / 9	9	9	Prior authorization required

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

Plan-by-plan detail — asciminib 20 MG Oral Tablet [Scemblix]

Scemblix has 3 products in the corpus; this table is for asciminib 20 MG Oral Tablet [Scemblix], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
Align ChoiceElite (PPO)	H8385-001	5	Yes	No	Yes
Align ChoiceElite (PPO)	H8385-002	5	Yes	No	Yes
Align ChoicePlus (PPO)	H8385-003	5	Yes	No	Yes
Align ChoicePlus (PPO)	H8385-004	5	Yes	No	Yes
Align Dual Partnership (HMO D-SNP)	H8967-003	5	Yes	No	Yes
Great Plain Medicare Advantage Gold (HMO I-SNP)	H1787-002	5	Yes	No	Yes
Great Plains Medicare Advantage (HMO I-SNP)	H1787-001	5	Yes	No	Yes
Great Plains Medicare Advantage (HMO I-SNP)	H8967-001	5	Yes	No	Yes
Great Plains Medicare Advantage Gold (HMO I-SNP)	H8967-002	5	Yes	No	Yes

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.

Scemblix at other payers

Or see Scemblix 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.