No prior authorization
Does Superior Healthplan, INC. require prior authorization for Matulane?
Superior Healthplan, INC. does not require prior authorization for Matulane 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 |
|---|---|---|---|---|---|
| procarbazine 50 MG Oral Capsule [Matulane]207588 | 15 / 15 | 0 | 0 | 0 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — procarbazine 50 MG Oral Capsule [Matulane]
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Wellcare Assist (HMO) | H5294-013 | 5 | No | No | No |
| Wellcare Assist (HMO) | H5294-016 | 5 | No | No | No |
| Wellcare Dual Access (HMO D-SNP) | H5294-015 | 5 | No | No | No |
| Wellcare Dual Liberty (HMO D-SNP) | H5294-010 | 5 | No | No | No |
| Wellcare Dual Liberty Sync (HMO D-SNP) | H5294-021 | 5 | No | No | No |
| Wellcare Dual Liberty Sync (HMO D-SNP) | H5294-022 | 5 | No | No | No |
| Wellcare Dual Liberty Sync (HMO D-SNP) | H5294-023 | 5 | No | No | No |
| Wellcare Dual Liberty Sync (HMO D-SNP) | H5294-024 | 5 | No | No | No |
| Wellcare Dual Liberty Sync (HMO D-SNP) | H5294-025 | 5 | No | No | No |
| Wellcare Giveback (HMO) | H5294-019 | 5 | No | No | No |
| Wellcare Simple (HMO) | H5294-011 | 5 | No | No | No |
| Wellcare Simple (HMO) | H5294-017 | 5 | No | No | No |
| Wellcare Simple (HMO) | H5294-018 | 5 | No | No | No |
| Wellcare Superior HealthPlan Dual Align (HMO D-SNP) | H0062-011 | 5 | No | No | No |
| Wellcare Superior HealthPlan Dual Align (HMO D-SNP) | H0062-012 | 5 | 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.
Matulane 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.