Does Uhc Of California require prior authorization for Koselugo?
Uhc Of California requires prior authorization for Koselugo on every Medicare Part D plan of theirs that covers it.
Every plan from this payer that covers the drug requires authorization before it is dispensed.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| selumetinib 10 MG Oral Capsule [Koselugo]2289424 | 40 / 40 | 40 | 0 | 40 | Prior authorization required |
| selumetinib 25 MG Oral Capsule [Koselugo]2289428 | 40 / 40 | 40 | 0 | 40 | Prior authorization required |
| selumetinib 5 MG Oral Granules [Koselugo]2723657 | 40 / 40 | 40 | 0 | 40 | Prior authorization required |
| selumetinib 7.5 MG Oral Granules [Koselugo]2723661 | 40 / 40 | 40 | 0 | 40 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — selumetinib 10 MG Oral Capsule [Koselugo]
Koselugo has 4 products in the corpus; this table is for selumetinib 10 MG Oral Capsule [Koselugo], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| AARP Medicare Advantage from UHC CA-0001 (HMO-POS) | H0543-013 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-0002 (HMO-POS) | H0543-019 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-0005 (HMO-POS) | H0543-035 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-0007 (HMO-POS) | H0543-060 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-0008 (HMO-POS) | H0543-086 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-0010 (HMO-POS) | H0543-140 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-0012 (HMO-POS) | H0543-152 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-0015 (HMO-POS) | H0543-166 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-003P (HMO-POS) | H0543-151 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-004P (HMO-POS) | H0543-168 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-005P (HMO-POS) | H0543-169 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-006P (HMO-POS) | H0543-170 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-021P (HMO-POS) | H0543-220 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-022P (HMO-POS) | H0543-221 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-023P (HMO-POS) | H0543-222 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-026P (HMO-POS) | H0543-225 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-10 (HMO-POS) | H0543-193 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-33 (HMO-POS) | H0543-232 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-37 (HMO-POS) | H0543-251 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-43 (HMO-POS) | H0543-254 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-44 (HMO-POS) | H0543-255 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-7 (HMO-POS) | H0543-188 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-8 (HMO-POS) | H0543-189 | 5 | Yes | No | Yes |
| AARP Medicare Advantage from UHC CA-9 (HMO-POS) | H0543-191 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Giveback from UHC CA-19 (HMO-POS) | H0543-236 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Giveback from UHC CA-20 (HMO-POS) | H0543-237 | 5 | Yes | No | Yes |
| AARP Medicare Advantage Giveback from UHC CA-21 (HMO-POS) | H0543-238 | 5 | Yes | No | Yes |
| UHC Complete Care CA-15P (HMO-POS C-SNP) | H0543-214 | 5 | Yes | No | Yes |
| UHC Complete Care CA-18P (HMO-POS C-SNP) | H0543-217 | 5 | Yes | No | Yes |
| UHC Complete Care CA-19P (HMO-POS C-SNP) | H0543-218 | 5 | Yes | No | Yes |
| UHC Complete Care CA-20P (HMO-POS C-SNP) | H0543-219 | 5 | Yes | No | Yes |
| UHC Complete Care CA-27P (HMO-POS C-SNP) | H0543-226 | 5 | Yes | No | Yes |
| UHC Complete Care Support CA-1AP (HMO C-SNP) | H0543-239 | 5 | Yes | No | Yes |
| UHC Complete Care Support CA-2AP (HMO C-SNP) | H0543-240 | 5 | Yes | No | Yes |
| UHC Complete Care Support CA-3AP (HMO C-SNP) | H0543-241 | 5 | Yes | No | Yes |
| UHC Complete Care Support CA-4AP (HMO C-SNP) | H0543-242 | 5 | Yes | No | Yes |
| UHC Complete Care Support CA-6AP (HMO C-SNP) | H0543-246 | 5 | Yes | No | Yes |
| UHC Complete Care Support CA-8AP (HMO-POS C-SNP) | H0543-249 | 5 | Yes | No | Yes |
| UHC Sharp Medicare Advantage CA-001P (HMO-POS) | H0543-145 | 5 | Yes | No | Yes |
| UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) | H0543-204 | 5 | Yes | No | Yes |
- 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.
Koselugo 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.