No prior authorization
Does Simply Healthcare Plans, INC. require prior authorization for Synthroid?
Simply Healthcare Plans, INC. does not require prior authorization for Synthroid 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 |
|---|---|---|---|---|---|
| levothyroxine sodium 0.125 MG Oral Tablet [Synthroid]966191 | 50 / 50 | 0 | 0 | 0 | No prior authorization |
| levothyroxine sodium 0.15 MG Oral Tablet [Synthroid]966201 | 50 / 50 | 0 | 0 | 0 | No prior authorization |
| levothyroxine sodium 0.175 MG Oral Tablet [Synthroid]966205 | 50 / 50 | 0 | 0 | 0 | No prior authorization |
| levothyroxine sodium 0.025 MG Oral Tablet [Synthroid]966158 | 50 / 50 | 0 | 0 | 0 | No prior authorization |
| levothyroxine sodium 0.075 MG Oral Tablet [Synthroid]966171 | 50 / 50 | 0 | 0 | 0 | No prior authorization |
| levothyroxine sodium 0.112 MG Oral Tablet [Synthroid]966185 | 50 / 50 | 0 | 0 | 0 | No prior authorization |
| levothyroxine sodium 0.3 MG Oral Tablet [Synthroid]966218 | 50 / 50 | 0 | 0 | 0 | No prior authorization |
| levothyroxine sodium 0.05 MG Oral Tablet [Synthroid]966247 | 50 / 50 | 0 | 0 | 0 | No prior authorization |
| levothyroxine sodium 0.1 MG Oral Tablet [Synthroid]966250 | 50 / 50 | 0 | 0 | 0 | No prior authorization |
| levothyroxine sodium 0.2 MG Oral Tablet [Synthroid]966251 | 50 / 50 | 0 | 0 | 0 | No prior authorization |
| levothyroxine sodium 0.137 MG Oral Tablet [Synthroid]966271 | 50 / 50 | 0 | 0 | 0 | No prior authorization |
| levothyroxine sodium 0.088 MG Oral Tablet [Synthroid]966282 | 50 / 50 | 0 | 0 | 0 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — levothyroxine sodium 0.125 MG Oral Tablet [Synthroid]
Synthroid has 12 products in the corpus; this table is for levothyroxine sodium 0.125 MG Oral Tablet [Synthroid], 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 | 3 | No | No | No |
| Simply Complete (HMO D-SNP) | H5471-066 | 3 | No | No | No |
| Simply Complete (HMO D-SNP) | H5471-072 | 3 | No | No | No |
| Simply Complete (HMO D-SNP) | H5471-076 | 3 | No | No | No |
| Simply Complete (HMO D-SNP) | H5471-082 | 3 | No | No | No |
| Simply Complete (HMO D-SNP) | H5471-084 | 3 | No | No | No |
| Simply Complete (HMO D-SNP) | H5471-111 | 3 | No | No | No |
| Simply Complete Platinum (HMO D-SNP) | H5471-115 | 3 | No | No | No |
| Simply Complete Platinum (HMO D-SNP) | H5471-118 | 3 | No | No | No |
| Simply Complete Platinum (HMO D-SNP) | H5471-121 | 3 | No | No | No |
| Simply Complete Platinum (HMO D-SNP) | H5471-125 | 3 | No | No | No |
| Simply Complete Platinum (HMO D-SNP) | H5471-138 | 3 | No | No | No |
| Simply Complete Platinum (HMO D-SNP) | H5471-140 | 3 | No | No | No |
| Simply Complete Platinum (HMO D-SNP) | H5471-142 | 3 | No | No | No |
| Simply Extra (HMO) | H5471-112 | 3 | No | No | No |
| Simply Extra Platinum (HMO) | H5471-113 | 3 | No | No | No |
| Simply Extra Platinum (HMO) | H5471-117 | 3 | No | No | No |
| Simply Extra Platinum (HMO) | H5471-120 | 3 | No | No | No |
| Simply Extra Platinum (HMO) | H5471-123 | 3 | No | No | No |
| Simply Integrated (HMO D-SNP) | H5471-127 | 3 | No | No | No |
| Simply Integrated (HMO D-SNP) | H5471-128 | 3 | No | No | No |
| Simply Integrated (HMO D-SNP) | H5471-129 | 3 | No | No | No |
| Simply Integrated (HMO D-SNP) | H5471-130 | 3 | No | No | No |
| Simply Integrated (HMO D-SNP) | H5471-131 | 3 | No | No | No |
| Simply Integrated (HMO D-SNP) | H5471-132 | 3 | No | No | No |
| Simply Integrated (HMO D-SNP) | H5471-133 | 3 | No | No | No |
| Simply Integrated Platinum (HMO D-SNP) | H5471-134 | 3 | No | No | No |
| Simply Integrated Platinum (HMO D-SNP) | H5471-135 | 3 | No | No | No |
| Simply Integrated Platinum (HMO D-SNP) | H5471-136 | 3 | No | No | No |
| Simply Integrated Platinum (HMO D-SNP) | H5471-137 | 3 | No | No | No |
| Simply Integrated Platinum (HMO D-SNP) | H5471-139 | 3 | No | No | No |
| Simply Integrated Platinum (HMO D-SNP) | H5471-141 | 3 | No | No | No |
| Simply Integrated Platinum (HMO D-SNP) | H5471-143 | 3 | No | No | No |
| Simply Level (HMO C-SNP) | H5471-069 | 3 | No | No | No |
| Simply Level (HMO C-SNP) | H5471-070 | 3 | No | No | No |
| Simply Level (HMO C-SNP) | H5471-073 | 3 | No | No | No |
| Simply Level (HMO C-SNP) | H5471-075 | 3 | No | No | No |
| Simply Level (HMO C-SNP) | H5471-080 | 3 | No | No | No |
| Simply Level Platinum (HMO C-SNP) | H5471-116 | 3 | No | No | No |
| Simply Level Platinum (HMO C-SNP) | H5471-119 | 3 | No | No | No |
| Simply Level Platinum (HMO C-SNP) | H5471-122 | 3 | No | No | No |
| Simply Level Platinum (HMO C-SNP) | H5471-126 | 3 | No | No | No |
| Simply More (HMO) | H5471-065 | 3 | No | No | No |
| Simply More (HMO) | H5471-071 | 3 | No | No | No |
| Simply More (HMO) | H5471-074 | 3 | No | No | No |
| Simply More (HMO) | H5471-077 | 3 | No | No | No |
| Simply More (HMO) | H5471-078 | 3 | No | No | No |
| Simply More (HMO) | H5471-110 | 3 | No | No | No |
| Simply More Platinum (HMO) | H5471-114 | 3 | No | No | No |
| Simply More Platinum (HMO) | H5471-124 | 3 | 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.
Synthroid 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.