Varies by plan

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

Prior authorization for Ingrezza differs across Simply Healthcare Plans, INC.'s Medicare Part D plans and product strengths — 5 of 7 Ingrezza 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
valbenazine 40 MG Oral Capsule [Ingrezza]1918230	50 / 50	50	50	Prior authorization required
valbenazine 80 MG Oral Capsule [Ingrezza]1986331	50 / 50	50	50	Prior authorization required
{7 (valbenazine 40 MG Oral Capsule [Ingrezza]) / 21 (valbenazine 80 MG Oral Capsule [Ingrezza]) } Pack [Ingrezza]2054269	50 / 50	50	50	Prior authorization required
valbenazine 60 MG Oral Capsule [Ingrezza]2541513	50 / 50	50	50	Prior authorization required
Sprinkle valbenazine 40 MG Oral Capsule [Ingrezza]2680780	50 / 50	50	50	Prior authorization required
Sprinkle valbenazine 60 MG Oral Capsule [Ingrezza]2680782	0 / 50	0	0	Not on formulary
Sprinkle valbenazine 80 MG Oral Capsule [Ingrezza]2680784	0 / 50	0	0	Not on formulary

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

Plan-by-plan detail — valbenazine 40 MG Oral Capsule [Ingrezza]

Ingrezza has 7 products in the corpus; this table is for valbenazine 40 MG Oral Capsule [Ingrezza], 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.

Ingrezza at other payers

Or see Ingrezza 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.