Prior authorization required

Does Ultimate Health Plans, INC. require prior authorization for Besremi?

Ultimate Health Plans, INC. requires prior authorization for Besremi 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
1 ML ropeginterferon alfa-2b-njft 0.5 MG/ML Prefilled Syringe [Besremi]2587070	16 / 16	16	0	0	Prior authorization required

Product names come from RxNorm (U.S. National Library of Medicine).

Plan-by-plan detail — 1 ML ropeginterferon alfa-2b-njft 0.5 MG/ML Prefilled Syringe [Besremi]

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
Advantage Care by Ultimate (HMO C-SNP)	H2962-021	5	Yes	No	No
Advantage Care by Ultimate (HMO C-SNP)	H2962-026	5	Yes	No	No
Advantage Care by Ultimate (HMO C-SNP)	H2962-029	5	Yes	No	No
Advantage Care by Ultimate (HMO C-SNP)	H2962-033	5	Yes	No	No
Advantage Care by Ultimate (HMO C-SNP)	H2962-050	5	Yes	No	No
Advantage Care by Ultimate (HMO C-SNP)	H2962-051	5	Yes	No	No
Advantage Care by Ultimate (HMO C-SNP)	H2962-052	5	Yes	No	No
Advantage Care COPD by Ultimate (HMO C-SNP)	H2962-023	5	Yes	No	No
Advantage Care COPD by Ultimate (HMO C-SNP)	H2962-025	5	Yes	No	No
Advantage Plus by Ultimate (Full) (HMO D-SNP)	H2962-035	5	Yes	No	No
Advantage Plus by Ultimate (Partial) (HMO D-SNP)	H2962-036	5	Yes	No	No
Premier by Ultimate (HMO)	H2962-001	5	Yes	No	No
Premier by Ultimate (HMO)	H2962-028	5	Yes	No	No
Premier by Ultimate (HMO)	H2962-045	5	Yes	No	No
Premier by Ultimate (HMO)	H2962-046	5	Yes	No	No
Premier by Ultimate (HMO)	H2962-047	5	Yes	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.

Besremi at other payers

Or see Besremi across every payer at once.

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.