No prior authorization
Does SCAN Health Plan require prior authorization for Nicotrol?
SCAN Health Plan does not require prior authorization for Nicotrol on the Medicare Part D plans that cover it.
No covering plan from this payer files a prior-authorization requirement for this drug.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| nicotine 0.5 MG/ACTUAT Metered Dose Nasal Spray [Nicotrol]1797888 | 74 / 74 | 0 | 0 | 0 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — nicotine 0.5 MG/ACTUAT Metered Dose Nasal Spray [Nicotrol]
| 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.
Nicotrol 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.