Does Ultimate Health Plans, INC. require prior authorization for Breo?
Ultimate Health Plans, INC. does not require prior authorization for Breo 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 |
|---|---|---|---|---|---|
| 30 ACTUAT fluticasone furoate 0.1 MG/ACTUAT / vilanterol 0.025 MG/ACTUAT Dry Powder Inhaler [Breo]1539893 | 16 / 16 | 0 | 0 | 16 | No prior authorization |
| 30 ACTUAT fluticasone furoate 0.2 MG/ACTUAT / vilanterol 0.025 MG/ACTUAT Dry Powder Inhaler [Breo]1648789 | 16 / 16 | 0 | 0 | 16 | No prior authorization |
| 30 ACTUAT fluticasone furoate 0.05 MG/ACTUAT / vilanterol 0.025 MG/ACTUAT Dry Powder Inhaler [Breo]2637476 | 16 / 16 | 0 | 0 | 16 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — 30 ACTUAT fluticasone furoate 0.1 MG/ACTUAT / vilanterol 0.025 MG/ACTUAT Dry Powder Inhaler [Breo]
Breo has 3 products in the corpus; this table is for 30 ACTUAT fluticasone furoate 0.1 MG/ACTUAT / vilanterol 0.025 MG/ACTUAT Dry Powder Inhaler [Breo], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Advantage Care by Ultimate (HMO C-SNP) | H2962-021 | 3 | No | No | Yes |
| Advantage Care by Ultimate (HMO C-SNP) | H2962-026 | 3 | No | No | Yes |
| Advantage Care by Ultimate (HMO C-SNP) | H2962-029 | 3 | No | No | Yes |
| Advantage Care by Ultimate (HMO C-SNP) | H2962-033 | 3 | No | No | Yes |
| Advantage Care by Ultimate (HMO C-SNP) | H2962-050 | 3 | No | No | Yes |
| Advantage Care by Ultimate (HMO C-SNP) | H2962-051 | 3 | No | No | Yes |
| Advantage Care by Ultimate (HMO C-SNP) | H2962-052 | 3 | No | No | Yes |
| Advantage Care COPD by Ultimate (HMO C-SNP) | H2962-023 | 3 | No | No | Yes |
| Advantage Care COPD by Ultimate (HMO C-SNP) | H2962-025 | 3 | No | No | Yes |
| Advantage Plus by Ultimate (Full) (HMO D-SNP) | H2962-035 | 3 | No | No | Yes |
| Advantage Plus by Ultimate (Partial) (HMO D-SNP) | H2962-036 | 3 | No | No | Yes |
| Premier by Ultimate (HMO) | H2962-001 | 3 | No | No | Yes |
| Premier by Ultimate (HMO) | H2962-028 | 3 | No | No | Yes |
| Premier by Ultimate (HMO) | H2962-045 | 3 | No | No | Yes |
| Premier by Ultimate (HMO) | H2962-046 | 3 | No | No | Yes |
| Premier by Ultimate (HMO) | H2962-047 | 3 | No | No | Yes |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
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Breo at other payers
Or see Breo 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.