Varies by plan

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

Prior authorization for Prograf differs across Simply Healthcare Plans, INC.'s Medicare Part D plans and product strengths — 2 of 5 Prograf 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	Status
tacrolimus 1 MG Oral Capsule [Prograf]108513	0 / 50	0	Not on formulary
tacrolimus 5 MG Oral Capsule [Prograf]108514	0 / 50	0	Not on formulary
tacrolimus 0.2 MG Granules for Oral Suspension [Prograf]2052609	50 / 50	50	Prior authorization required
tacrolimus 1 MG Granules for Oral Suspension [Prograf]2052704	50 / 50	50	Prior authorization required
tacrolimus 0.5 MG Oral Capsule [Prograf]261134	0 / 50	0	Not on formulary

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

Plan-by-plan detail — tacrolimus 0.2 MG Granules for Oral Suspension [Prograf]

Prograf has 5 products in the corpus; this table is for tacrolimus 0.2 MG Granules for Oral Suspension [Prograf], 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	4	Yes	No	No
Simply Complete (HMO D-SNP)	H5471-066	4	Yes	No	No
Simply Complete (HMO D-SNP)	H5471-072	4	Yes	No	No
Simply Complete (HMO D-SNP)	H5471-076	4	Yes	No	No
Simply Complete (HMO D-SNP)	H5471-082	4	Yes	No	No
Simply Complete (HMO D-SNP)	H5471-084	4	Yes	No	No
Simply Complete (HMO D-SNP)	H5471-111	4	Yes	No	No
Simply Complete Platinum (HMO D-SNP)	H5471-115	4	Yes	No	No
Simply Complete Platinum (HMO D-SNP)	H5471-118	4	Yes	No	No
Simply Complete Platinum (HMO D-SNP)	H5471-121	4	Yes	No	No
Simply Complete Platinum (HMO D-SNP)	H5471-125	4	Yes	No	No
Simply Complete Platinum (HMO D-SNP)	H5471-138	4	Yes	No	No
Simply Complete Platinum (HMO D-SNP)	H5471-140	4	Yes	No	No
Simply Complete Platinum (HMO D-SNP)	H5471-142	4	Yes	No	No
Simply Extra (HMO)	H5471-112	4	Yes	No	No
Simply Extra Platinum (HMO)	H5471-113	4	Yes	No	No
Simply Extra Platinum (HMO)	H5471-117	4	Yes	No	No
Simply Extra Platinum (HMO)	H5471-120	4	Yes	No	No
Simply Extra Platinum (HMO)	H5471-123	4	Yes	No	No
Simply Integrated (HMO D-SNP)	H5471-127	4	Yes	No	No
Simply Integrated (HMO D-SNP)	H5471-128	4	Yes	No	No
Simply Integrated (HMO D-SNP)	H5471-129	4	Yes	No	No
Simply Integrated (HMO D-SNP)	H5471-130	4	Yes	No	No
Simply Integrated (HMO D-SNP)	H5471-131	4	Yes	No	No
Simply Integrated (HMO D-SNP)	H5471-132	4	Yes	No	No
Simply Integrated (HMO D-SNP)	H5471-133	4	Yes	No	No
Simply Integrated Platinum (HMO D-SNP)	H5471-134	4	Yes	No	No
Simply Integrated Platinum (HMO D-SNP)	H5471-135	4	Yes	No	No
Simply Integrated Platinum (HMO D-SNP)	H5471-136	4	Yes	No	No
Simply Integrated Platinum (HMO D-SNP)	H5471-137	4	Yes	No	No
Simply Integrated Platinum (HMO D-SNP)	H5471-139	4	Yes	No	No
Simply Integrated Platinum (HMO D-SNP)	H5471-141	4	Yes	No	No
Simply Integrated Platinum (HMO D-SNP)	H5471-143	4	Yes	No	No
Simply Level (HMO C-SNP)	H5471-069	4	Yes	No	No
Simply Level (HMO C-SNP)	H5471-070	4	Yes	No	No
Simply Level (HMO C-SNP)	H5471-073	4	Yes	No	No
Simply Level (HMO C-SNP)	H5471-075	4	Yes	No	No
Simply Level (HMO C-SNP)	H5471-080	4	Yes	No	No
Simply Level Platinum (HMO C-SNP)	H5471-116	4	Yes	No	No
Simply Level Platinum (HMO C-SNP)	H5471-119	4	Yes	No	No
Simply Level Platinum (HMO C-SNP)	H5471-122	4	Yes	No	No
Simply Level Platinum (HMO C-SNP)	H5471-126	4	Yes	No	No
Simply More (HMO)	H5471-065	4	Yes	No	No
Simply More (HMO)	H5471-071	4	Yes	No	No
Simply More (HMO)	H5471-074	4	Yes	No	No
Simply More (HMO)	H5471-077	4	Yes	No	No
Simply More (HMO)	H5471-078	4	Yes	No	No
Simply More (HMO)	H5471-110	4	Yes	No	No
Simply More Platinum (HMO)	H5471-114	4	Yes	No	No
Simply More Platinum (HMO)	H5471-124	4	Yes	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.

Prograf at other payers

Or see Prograf 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.