Varies by plan

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

Prior authorization for Retevmo differs across Ultimate Health Plans, INC.'s Medicare Part D plans and product strengths — 3 of 4 Retevmo products in the corpus appear on their formularies, and the requirement is not uniform. Check the member's specific plan.

Some plans require authorization and others do not. The member's specific plan decides.

This drug does not appear on any of this payer's Medicare Part D formularies. That means it is NOT COVERED under those plans — which is a different and generally worse outcome than requiring prior authorization. An exception or formulary-exception request may still be possible.

By product strength

RxNorm product	Plans covering	Require prior auth	Qty limit	Status
selpercatinib 120 MG Oral Tablet [Retevmo]2679808	16 / 16	16	0	Prior authorization required
selpercatinib 160 MG Oral Tablet [Retevmo]2679812	16 / 16	16	0	Prior authorization required
selpercatinib 40 MG Oral Tablet [Retevmo]2679814	16 / 16	16	16	Prior authorization required
selpercatinib 80 MG Oral Tablet [Retevmo]2679816	0 / 16	0	0	Not on formulary

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

Plan-by-plan detail — selpercatinib 120 MG Oral Tablet [Retevmo]

Retevmo has 4 products in the corpus; this table is for selpercatinib 120 MG Oral Tablet [Retevmo], 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	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.

Retevmo at other payers

Or see Retevmo 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.