Does Summacare INC. require prior authorization for Fanapt?
Summacare INC. does not require prior authorization for Fanapt on the Medicare Part D plans that cover it.
No covering plan from this payer files a prior-authorization requirement for this drug.
- No prior authorization is filed, but step therapy applies on 7 of 7 covering plans — the plan requires another drug be tried first.
- 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 | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| iloperidone 1 MG Oral Tablet [Fanapt]848726 | 7 / 7 | 0 | 7 | 7 | No prior authorization |
| iloperidone 10 MG Oral Tablet [Fanapt]848730 | 7 / 7 | 0 | 7 | 7 | No prior authorization |
| iloperidone 12 MG Oral Tablet [Fanapt]848734 | 7 / 7 | 0 | 7 | 7 | No prior authorization |
| iloperidone 2 MG Oral Tablet [Fanapt]848738 | 0 / 7 | 0 | 0 | 0 | Not on formulary |
| iloperidone 4 MG Oral Tablet [Fanapt]848742 | 0 / 7 | 0 | 0 | 0 | Not on formulary |
| iloperidone 6 MG Oral Tablet [Fanapt]848746 | 0 / 7 | 0 | 0 | 0 | Not on formulary |
| iloperidone 8 MG Oral Tablet [Fanapt]848750 | 0 / 7 | 0 | 0 | 0 | Not on formulary |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — iloperidone 1 MG Oral Tablet [Fanapt]
Fanapt has 7 products in the corpus; this table is for iloperidone 1 MG Oral Tablet [Fanapt], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| SummaCare Medicare Emerald (HMO-POS) | H3660-028 | 5 | No | Yes | Yes |
| SummaCare Medicare Garnet (HMO) | H3660-053 | 5 | No | Yes | Yes |
| SummaCare Medicare Garnet (HMO) | H3660-053 | 5 | No | Yes | Yes |
| SummaCare Medicare Quartz (HMO) | H3660-057 | 5 | No | Yes | Yes |
| SummaCare Medicare Ruby (HMO) | H3660-044 | 5 | No | Yes | Yes |
| SummaCare Medicare Sapphire (HMO-POS) | H3660-029 | 5 | No | Yes | Yes |
| SummaCare Medicare Topaz (HMO) | H3660-050 | 5 | No | Yes | Yes |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
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Fanapt 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.