No prior authorization
Does SCAN Health Plan require prior authorization for Kaletra?
SCAN Health Plan does not require prior authorization for Kaletra on the Medicare Part D plans that cover it.
No covering plan from this payer files a prior-authorization requirement for this drug.
- 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 |
|---|---|---|---|---|---|
| lopinavir 200 MG / ritonavir 50 MG Oral Tablet [Kaletra]847741 | 0 / 74 | 0 | 0 | 0 | Not on formulary |
| lopinavir 100 MG / ritonavir 25 MG Oral Tablet [Kaletra]847745 | 0 / 74 | 0 | 0 | 0 | Not on formulary |
| lopinavir 80 MG/ML / ritonavir 20 MG/ML Oral Solution [Kaletra]847749 | 74 / 74 | 0 | 0 | 0 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — lopinavir 80 MG/ML / ritonavir 20 MG/ML Oral Solution [Kaletra]
Kaletra has 3 products in the corpus; this table is for lopinavir 80 MG/ML / ritonavir 20 MG/ML Oral Solution [Kaletra], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| SCAN Affirm partnered with Included LGBTQ+ Health (HMO) | H5425-092 | 4 | No | No | No |
| SCAN Affirm partnered with Included LGBTQ+ Health (HMO) | H5425-096 | 4 | No | No | No |
| SCAN Affirm partnered with Included LGBTQ+ Health (HMO) | H5425-107 | 4 | No | No | No |
| SCAN Allied (HMO) | H5425-118 | 4 | No | No | No |
| SCAN Allied (HMO) | H5425-123 | 4 | No | No | No |
| SCAN Alta (HMO) | H5425-082 | 4 | No | No | No |
| SCAN Balance (HMO C-SNP) | H0978-002 | 4 | No | No | No |
| SCAN Balance (HMO C-SNP) | H1822-002 | 4 | No | No | No |
| SCAN Balance (HMO C-SNP) | H5244-002 | 4 | No | No | No |
| SCAN Balance (HMO C-SNP) | H5425-034 | 4 | No | No | No |
| SCAN Balance (HMO C-SNP) | H5425-070 | 4 | No | No | No |
| SCAN Balance (HMO C-SNP) | H5425-076 | 4 | No | No | No |
| SCAN Balance (HMO C-SNP) | H5425-102 | 4 | No | No | No |
| SCAN Balance (HMO C-SNP) | H5425-104 | 4 | No | No | No |
| SCAN Balance (HMO C-SNP) | H5425-105 | 4 | No | No | No |
| SCAN Balance (HMO C-SNP) | H5425-106 | 4 | No | No | No |
| SCAN Balance (HMO C-SNP) | H5425-129 | 4 | No | No | No |
| SCAN Balance Texas (HMO C-SNP) | H8902-002 | 4 | No | No | No |
| SCAN Classic (HMO) | H0978-001 | 4 | No | No | No |
| SCAN Classic (HMO) | H1822-001 | 4 | No | No | No |
| SCAN Classic (HMO) | H5244-001 | 4 | No | No | No |
| SCAN Classic (HMO) | H5425-001 | 4 | No | No | No |
| SCAN Classic (HMO) | H5425-005 | 4 | No | No | No |
| SCAN Classic (HMO) | H5425-006 | 4 | No | No | No |
| SCAN Classic (HMO) | H5425-007 | 4 | No | No | No |
| SCAN Classic (HMO) | H5425-008 | 4 | No | No | No |
| SCAN Classic (HMO) | H5425-009 | 4 | No | No | No |
| SCAN Classic (HMO) | H5425-019 | 4 | No | No | No |
| SCAN Classic (HMO) | H5425-069 | 4 | No | No | No |
| SCAN Classic (HMO) | H5425-075 | 4 | No | No | No |
| SCAN Classic (HMO) | H5425-101 | 4 | No | No | No |
| SCAN Classic (HMO) | H5425-128 | 4 | No | No | No |
| SCAN Classic Texas (HMO) | H8902-010 | 4 | No | No | No |
| SCAN Classic WA (HMO) | H4026-001 | 4 | No | No | No |
| SCAN Compass (HMO) | H5425-124 | 4 | No | No | No |
| SCAN Connections (HMO D-SNP) | H0976-001 | 4 | No | No | No |
| SCAN Connections at Home (HMO D-SNP) | H0976-002 | 4 | No | No | No |
| SCAN Desert Choice (HMO) | H5425-135 | 4 | No | No | No |
| SCAN Embrace (HMO I-SNP) | H5425-086 | 4 | No | No | No |
| SCAN Embrace (HMO I-SNP) | H5425-087 | 4 | No | No | No |
| SCAN Embrace (HMO-POS I-SNP) | H1822-005 | 4 | No | No | No |
| SCAN Embrace (HMO-POS I-SNP) | H5425-091 | 4 | No | No | No |
| SCAN Embrace Together (HMO I-SNP) | H5425-131 | 4 | No | No | No |
| SCAN Embrace Together (HMO-POS I-SNP) | H1822-008 | 4 | No | No | No |
| SCAN Embrace Together (HMO-POS I-SNP) | H5425-132 | 4 | No | No | No |
| SCAN Essential Savings (HMO) | H5425-133 | 4 | No | No | No |
| SCAN Inspired by women for women (HMO) | H5425-100 | 4 | No | No | No |
| SCAN MyChoice (HMO) | H0978-011 | 4 | No | No | No |
| SCAN MyChoice (HMO) | H1822-007 | 4 | No | No | No |
| SCAN MyChoice (HMO) | H5244-005 | 4 | No | No | No |
| SCAN MyChoice (HMO) | H5425-108 | 4 | No | No | No |
| SCAN MyChoice (HMO) | H5425-109 | 4 | No | No | No |
| SCAN MyChoice (HMO) | H5425-110 | 4 | No | No | No |
| SCAN MyChoice (HMO) | H5425-119 | 4 | No | No | No |
| SCAN MyChoice (HMO) | H5425-120 | 4 | No | No | No |
| SCAN MyChoice (HMO) | H5425-121 | 4 | No | No | No |
| SCAN MyChoice (HMO) | H5425-130 | 4 | No | No | No |
| SCAN MyChoice Texas (HMO) | H8902-011 | 4 | No | No | No |
| SCAN MyChoice WA (HMO) | H4026-002 | 4 | No | No | No |
| SCAN Prime (HMO) | H5425-065 | 4 | No | No | No |
| SCAN Select (HMO) | H5425-134 | 4 | No | No | No |
| SCAN Strive (HMO C-SNP) | H0978-010 | 4 | No | No | No |
| SCAN Strive (HMO C-SNP) | H1822-006 | 4 | No | No | No |
| SCAN Strive (HMO C-SNP) | H5244-004 | 4 | No | No | No |
| SCAN Strive (HMO C-SNP) | H5425-097 | 4 | No | No | No |
| SCAN Strive (HMO C-SNP) | H5425-098 | 4 | No | No | No |
| SCAN Strive Texas (HMO C-SNP) | H8902-009 | 4 | No | No | No |
| SCAN Venture (HMO) | H5425-084 | 4 | No | No | No |
| SCAN Venture (HMO) | H5425-085 | 4 | No | No | No |
| Sutter Senior Advantage, a SCAN Medicare Plan (HMO) | H5425-125 | 4 | No | No | No |
| Sutter Senior Advantage, a SCAN Medicare Plan (HMO) | H5425-126 | 4 | No | No | No |
| Sutter Senior Advantage, a SCAN Medicare Plan (HMO) | H5425-127 | 4 | No | No | No |
| VillageHealth (HMO-POS C-SNP) | H5943-003 | 4 | No | No | No |
| VillageHealth (HMO-POS C-SNP) | H5943-004 | 4 | No | 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.
Kaletra 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.