Prior authorization required

Does Simply Healthcare Plans, INC. require prior authorization for Briviact?

Simply Healthcare Plans, INC. requires prior authorization for Briviact 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
brivaracetam 10 MG Oral Tablet [Briviact]1739766	50 / 50	50	50	Prior authorization required
brivaracetam 100 MG Oral Tablet [Briviact]1739770	50 / 50	50	50	Prior authorization required
brivaracetam 25 MG Oral Tablet [Briviact]1739774	50 / 50	50	50	Prior authorization required
brivaracetam 50 MG Oral Tablet [Briviact]1739778	50 / 50	50	50	Prior authorization required
brivaracetam 75 MG Oral Tablet [Briviact]1739782	50 / 50	50	50	Prior authorization required
brivaracetam 10 MG/ML Oral Solution [Briviact]1739788	50 / 50	50	50	Prior authorization required

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

Plan-by-plan detail — brivaracetam 10 MG Oral Tablet [Briviact]

Briviact has 6 products in the corpus; this table is for brivaracetam 10 MG Oral Tablet [Briviact], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
Simply Complete (HMO D-SNP)	H5471-064	5	Yes	No	Yes
Simply Complete (HMO D-SNP)	H5471-066	5	Yes	No	Yes
Simply Complete (HMO D-SNP)	H5471-072	5	Yes	No	Yes
Simply Complete (HMO D-SNP)	H5471-076	5	Yes	No	Yes
Simply Complete (HMO D-SNP)	H5471-082	5	Yes	No	Yes
Simply Complete (HMO D-SNP)	H5471-084	5	Yes	No	Yes
Simply Complete (HMO D-SNP)	H5471-111	5	Yes	No	Yes
Simply Complete Platinum (HMO D-SNP)	H5471-115	5	Yes	No	Yes
Simply Complete Platinum (HMO D-SNP)	H5471-118	5	Yes	No	Yes
Simply Complete Platinum (HMO D-SNP)	H5471-121	5	Yes	No	Yes
Simply Complete Platinum (HMO D-SNP)	H5471-125	5	Yes	No	Yes
Simply Complete Platinum (HMO D-SNP)	H5471-138	5	Yes	No	Yes
Simply Complete Platinum (HMO D-SNP)	H5471-140	5	Yes	No	Yes
Simply Complete Platinum (HMO D-SNP)	H5471-142	5	Yes	No	Yes
Simply Extra (HMO)	H5471-112	5	Yes	No	Yes
Simply Extra Platinum (HMO)	H5471-113	5	Yes	No	Yes
Simply Extra Platinum (HMO)	H5471-117	5	Yes	No	Yes
Simply Extra Platinum (HMO)	H5471-120	5	Yes	No	Yes
Simply Extra Platinum (HMO)	H5471-123	5	Yes	No	Yes
Simply Integrated (HMO D-SNP)	H5471-127	5	Yes	No	Yes
Simply Integrated (HMO D-SNP)	H5471-128	5	Yes	No	Yes
Simply Integrated (HMO D-SNP)	H5471-129	5	Yes	No	Yes
Simply Integrated (HMO D-SNP)	H5471-130	5	Yes	No	Yes
Simply Integrated (HMO D-SNP)	H5471-131	5	Yes	No	Yes
Simply Integrated (HMO D-SNP)	H5471-132	5	Yes	No	Yes
Simply Integrated (HMO D-SNP)	H5471-133	5	Yes	No	Yes
Simply Integrated Platinum (HMO D-SNP)	H5471-134	5	Yes	No	Yes
Simply Integrated Platinum (HMO D-SNP)	H5471-135	5	Yes	No	Yes
Simply Integrated Platinum (HMO D-SNP)	H5471-136	5	Yes	No	Yes
Simply Integrated Platinum (HMO D-SNP)	H5471-137	5	Yes	No	Yes
Simply Integrated Platinum (HMO D-SNP)	H5471-139	5	Yes	No	Yes
Simply Integrated Platinum (HMO D-SNP)	H5471-141	5	Yes	No	Yes
Simply Integrated Platinum (HMO D-SNP)	H5471-143	5	Yes	No	Yes
Simply Level (HMO C-SNP)	H5471-069	5	Yes	No	Yes
Simply Level (HMO C-SNP)	H5471-070	5	Yes	No	Yes
Simply Level (HMO C-SNP)	H5471-073	5	Yes	No	Yes
Simply Level (HMO C-SNP)	H5471-075	5	Yes	No	Yes
Simply Level (HMO C-SNP)	H5471-080	5	Yes	No	Yes
Simply Level Platinum (HMO C-SNP)	H5471-116	5	Yes	No	Yes
Simply Level Platinum (HMO C-SNP)	H5471-119	5	Yes	No	Yes
Simply Level Platinum (HMO C-SNP)	H5471-122	5	Yes	No	Yes
Simply Level Platinum (HMO C-SNP)	H5471-126	5	Yes	No	Yes
Simply More (HMO)	H5471-065	5	Yes	No	Yes
Simply More (HMO)	H5471-071	5	Yes	No	Yes
Simply More (HMO)	H5471-074	5	Yes	No	Yes
Simply More (HMO)	H5471-077	5	Yes	No	Yes
Simply More (HMO)	H5471-078	5	Yes	No	Yes
Simply More (HMO)	H5471-110	5	Yes	No	Yes
Simply More Platinum (HMO)	H5471-114	5	Yes	No	Yes
Simply More Platinum (HMO)	H5471-124	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.

Briviact at other payers

Or see Briviact 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.