No prior authorization
Does Triple S Advantage, INC. require prior authorization for Rotarix?
Triple S Advantage, INC. does not require prior authorization for Rotarix 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 |
|---|---|---|---|---|---|
| rotavirus vaccine, live attenuated, G1P[8] human 89-12 strain 667000 UNT/ML Oral Suspension [Rotarix]2627825 | 22 / 22 | 0 | 0 | 0 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — rotavirus vaccine, live attenuated, G1P[8] human 89-12 strain 667000 UNT/ML Oral Suspension [Rotarix]
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Ahorro Plus (HMO) | H5774-047 | 6 | No | No | No |
| Ahorro Plus (HMO) | H5774-047 | 6 | No | No | No |
| Ahorro Plus (HMO) | H5774-047 | 6 | No | No | No |
| Ahorro Plus (HMO) | H5774-047 | 6 | No | No | No |
| Ahorro Plus (HMO) | H5774-047 | 6 | No | No | No |
| Brillante (HMO-POS) | H5774-031 | 6 | No | No | No |
| Contigo Plus (HMO C-SNP) | H5774-022 | 6 | No | No | No |
| ContigoEnMente (HMO C-SNP) | H5774-046 | 6 | No | No | No |
| Enlace Plus (HMO) | H5774-038 | 6 | No | No | No |
| PLATINO ADVANCE (HMO D-SNP) | H5774-041 | 1 | No | No | No |
| PLATINO ADVANCE (HMO D-SNP) | H5774-041 | 1 | No | No | No |
| PLATINO ADVANCE (HMO D-SNP) | H5774-041 | 1 | No | No | No |
| PLATINO ADVANCE (HMO D-SNP) | H5774-041 | 1 | No | No | No |
| PLATINO ADVANCE (HMO D-SNP) | H5774-041 | 1 | No | No | No |
| Platino Blindao (HMO D-SNP) | H5774-028 | 1 | No | No | No |
| Platino Enlace (HMO D-SNP) | H5774-035 | 1 | No | No | No |
| PLATINO PLUS (HMO D-SNP) | H5774-043 | 1 | No | No | No |
| PLATINO PLUS (HMO D-SNP) | H5774-043 | 1 | No | No | No |
| PLATINO PLUS (HMO D-SNP) | H5774-043 | 1 | No | No | No |
| PLATINO PLUS (HMO D-SNP) | H5774-043 | 1 | No | No | No |
| PLATINO PLUS (HMO D-SNP) | H5774-043 | 1 | No | No | No |
| �ptimo Plus (PPO) | H4005-004 | 6 | 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.
Rotarix 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.