Does Ultimate Health Plans, INC. require prior authorization for Synjardy?
Ultimate Health Plans, INC. does not require prior authorization for Synjardy on the Medicare Part D plans that cover it.
No covering plan from this payer files a prior-authorization requirement for this drug.
- 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 | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| empagliflozin 5 MG / metformin hydrochloride 500 MG Oral Tablet [Synjardy]1664321 | 16 / 16 | 0 | 0 | 0 | No prior authorization |
| empagliflozin 12.5 MG / metformin hydrochloride 500 MG Oral Tablet [Synjardy]1664325 | 16 / 16 | 0 | 0 | 0 | No prior authorization |
| empagliflozin 5 MG / metformin hydrochloride 1000 MG Oral Tablet [Synjardy]1664328 | 16 / 16 | 0 | 0 | 0 | No prior authorization |
| empagliflozin 12.5 MG / metformin hydrochloride 1000 MG Oral Tablet [Synjardy]1665369 | 16 / 16 | 0 | 0 | 0 | No prior authorization |
| 24 HR empagliflozin 10 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Synjardy]1862688 | 0 / 16 | 0 | 0 | 0 | Not on formulary |
| 24 HR empagliflozin 12.5 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Synjardy]1862692 | 0 / 16 | 0 | 0 | 0 | Not on formulary |
| 24 HR empagliflozin 25 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Synjardy]1862697 | 0 / 16 | 0 | 0 | 0 | Not on formulary |
| 24 HR empagliflozin 5 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Synjardy]1862701 | 0 / 16 | 0 | 0 | 0 | Not on formulary |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — empagliflozin 5 MG / metformin hydrochloride 500 MG Oral Tablet [Synjardy]
Synjardy has 8 products in the corpus; this table is for empagliflozin 5 MG / metformin hydrochloride 500 MG Oral Tablet [Synjardy], 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 | 6 | No | No | No |
| Advantage Care by Ultimate (HMO C-SNP) | H2962-026 | 6 | No | No | No |
| Advantage Care by Ultimate (HMO C-SNP) | H2962-029 | 6 | No | No | No |
| Advantage Care by Ultimate (HMO C-SNP) | H2962-033 | 6 | No | No | No |
| Advantage Care by Ultimate (HMO C-SNP) | H2962-050 | 6 | No | No | No |
| Advantage Care by Ultimate (HMO C-SNP) | H2962-051 | 6 | No | No | No |
| Advantage Care by Ultimate (HMO C-SNP) | H2962-052 | 6 | No | No | No |
| Advantage Care COPD by Ultimate (HMO C-SNP) | H2962-023 | 6 | No | No | No |
| Advantage Care COPD by Ultimate (HMO C-SNP) | H2962-025 | 6 | No | No | No |
| Advantage Plus by Ultimate (Full) (HMO D-SNP) | H2962-035 | 3 | No | No | No |
| Advantage Plus by Ultimate (Partial) (HMO D-SNP) | H2962-036 | 3 | No | No | No |
| Premier by Ultimate (HMO) | H2962-001 | 3 | No | No | No |
| Premier by Ultimate (HMO) | H2962-028 | 3 | No | No | No |
| Premier by Ultimate (HMO) | H2962-045 | 3 | No | No | No |
| Premier by Ultimate (HMO) | H2962-046 | 3 | No | No | No |
| Premier by Ultimate (HMO) | H2962-047 | 3 | No | No | No |
- 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.
Synjardy 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.