Varies by plan

Does SCAN Health Plan require prior authorization for Rinvoq?

Prior authorization for Rinvoq differs across SCAN Health Plan's Medicare Part D plans and product strengths — 3 of 4 Rinvoq products in the corpus appear on their formularies, and the requirement is not uniform. Check the member's specific plan.

Some plans require authorization and others do not. The member's specific plan decides.

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	Qty limit	Status
24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq]2196900	74 / 74	74	74	Prior authorization required
24 HR upadacitinib 30 MG Extended Release Oral Tablet [Rinvoq]2590054	74 / 74	74	74	Prior authorization required
24 HR upadacitinib 45 MG Extended Release Oral Tablet [Rinvoq]2596960	74 / 74	74	74	Prior authorization required
upadacitinib 1 MG/ML Oral Solution [Rinvoq]2681019	0 / 74	0	0	Not on formulary

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

Plan-by-plan detail — 24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq]

Rinvoq has 4 products in the corpus; this table is for 24 HR upadacitinib 15 MG Extended Release Oral Tablet [Rinvoq], 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	5	Yes	No	Yes
SCAN Affirm partnered with Included LGBTQ+ Health (HMO)	H5425-096	5	Yes	No	Yes
SCAN Affirm partnered with Included LGBTQ+ Health (HMO)	H5425-107	5	Yes	No	Yes
SCAN Allied (HMO)	H5425-118	5	Yes	No	Yes
SCAN Allied (HMO)	H5425-123	5	Yes	No	Yes
SCAN Alta (HMO)	H5425-082	5	Yes	No	Yes
SCAN Balance (HMO C-SNP)	H0978-002	5	Yes	No	Yes
SCAN Balance (HMO C-SNP)	H1822-002	5	Yes	No	Yes
SCAN Balance (HMO C-SNP)	H5244-002	5	Yes	No	Yes
SCAN Balance (HMO C-SNP)	H5425-034	5	Yes	No	Yes
SCAN Balance (HMO C-SNP)	H5425-070	5	Yes	No	Yes
SCAN Balance (HMO C-SNP)	H5425-076	5	Yes	No	Yes
SCAN Balance (HMO C-SNP)	H5425-102	5	Yes	No	Yes
SCAN Balance (HMO C-SNP)	H5425-104	5	Yes	No	Yes
SCAN Balance (HMO C-SNP)	H5425-105	5	Yes	No	Yes
SCAN Balance (HMO C-SNP)	H5425-106	5	Yes	No	Yes
SCAN Balance (HMO C-SNP)	H5425-129	5	Yes	No	Yes
SCAN Balance Texas (HMO C-SNP)	H8902-002	5	Yes	No	Yes
SCAN Classic (HMO)	H0978-001	5	Yes	No	Yes
SCAN Classic (HMO)	H1822-001	5	Yes	No	Yes
SCAN Classic (HMO)	H5244-001	5	Yes	No	Yes
SCAN Classic (HMO)	H5425-001	5	Yes	No	Yes
SCAN Classic (HMO)	H5425-005	5	Yes	No	Yes
SCAN Classic (HMO)	H5425-006	5	Yes	No	Yes
SCAN Classic (HMO)	H5425-007	5	Yes	No	Yes
SCAN Classic (HMO)	H5425-008	5	Yes	No	Yes
SCAN Classic (HMO)	H5425-009	5	Yes	No	Yes
SCAN Classic (HMO)	H5425-019	5	Yes	No	Yes
SCAN Classic (HMO)	H5425-069	5	Yes	No	Yes
SCAN Classic (HMO)	H5425-075	5	Yes	No	Yes
SCAN Classic (HMO)	H5425-101	5	Yes	No	Yes
SCAN Classic (HMO)	H5425-128	5	Yes	No	Yes
SCAN Classic Texas (HMO)	H8902-010	5	Yes	No	Yes
SCAN Classic WA (HMO)	H4026-001	5	Yes	No	Yes
SCAN Compass (HMO)	H5425-124	5	Yes	No	Yes
SCAN Connections (HMO D-SNP)	H0976-001	5	Yes	No	Yes
SCAN Connections at Home (HMO D-SNP)	H0976-002	5	Yes	No	Yes
SCAN Desert Choice (HMO)	H5425-135	5	Yes	No	Yes
SCAN Embrace (HMO I-SNP)	H5425-086	5	Yes	No	Yes
SCAN Embrace (HMO I-SNP)	H5425-087	5	Yes	No	Yes
SCAN Embrace (HMO-POS I-SNP)	H1822-005	5	Yes	No	Yes
SCAN Embrace (HMO-POS I-SNP)	H5425-091	5	Yes	No	Yes
SCAN Embrace Together (HMO I-SNP)	H5425-131	5	Yes	No	Yes
SCAN Embrace Together (HMO-POS I-SNP)	H1822-008	5	Yes	No	Yes
SCAN Embrace Together (HMO-POS I-SNP)	H5425-132	5	Yes	No	Yes
SCAN Essential Savings (HMO)	H5425-133	5	Yes	No	Yes
SCAN Inspired by women for women (HMO)	H5425-100	5	Yes	No	Yes
SCAN MyChoice (HMO)	H0978-011	5	Yes	No	Yes
SCAN MyChoice (HMO)	H1822-007	5	Yes	No	Yes
SCAN MyChoice (HMO)	H5244-005	5	Yes	No	Yes
SCAN MyChoice (HMO)	H5425-108	5	Yes	No	Yes
SCAN MyChoice (HMO)	H5425-109	5	Yes	No	Yes
SCAN MyChoice (HMO)	H5425-110	5	Yes	No	Yes
SCAN MyChoice (HMO)	H5425-119	5	Yes	No	Yes
SCAN MyChoice (HMO)	H5425-120	5	Yes	No	Yes
SCAN MyChoice (HMO)	H5425-121	5	Yes	No	Yes
SCAN MyChoice (HMO)	H5425-130	5	Yes	No	Yes
SCAN MyChoice Texas (HMO)	H8902-011	5	Yes	No	Yes
SCAN MyChoice WA (HMO)	H4026-002	5	Yes	No	Yes
SCAN Prime (HMO)	H5425-065	5	Yes	No	Yes
SCAN Select (HMO)	H5425-134	5	Yes	No	Yes
SCAN Strive (HMO C-SNP)	H0978-010	5	Yes	No	Yes
SCAN Strive (HMO C-SNP)	H1822-006	5	Yes	No	Yes
SCAN Strive (HMO C-SNP)	H5244-004	5	Yes	No	Yes
SCAN Strive (HMO C-SNP)	H5425-097	5	Yes	No	Yes
SCAN Strive (HMO C-SNP)	H5425-098	5	Yes	No	Yes
SCAN Strive Texas (HMO C-SNP)	H8902-009	5	Yes	No	Yes
SCAN Venture (HMO)	H5425-084	5	Yes	No	Yes
SCAN Venture (HMO)	H5425-085	5	Yes	No	Yes
Sutter Senior Advantage, a SCAN Medicare Plan (HMO)	H5425-125	5	Yes	No	Yes
Sutter Senior Advantage, a SCAN Medicare Plan (HMO)	H5425-126	5	Yes	No	Yes
Sutter Senior Advantage, a SCAN Medicare Plan (HMO)	H5425-127	5	Yes	No	Yes
VillageHealth (HMO-POS C-SNP)	H5943-003	5	Yes	No	Yes
VillageHealth (HMO-POS C-SNP)	H5943-004	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.

Rinvoq at other payers

Or see Rinvoq 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.