No prior authorization
Does UnitedHealthcare require prior authorization for Fetzima?
UnitedHealthcare does not require prior authorization for Fetzima on the Medicare Part D plans that cover it.
No covering plan from this payer files a prior-authorization requirement for this drug.
- No prior authorization is filed, but step therapy applies on 731 of 731 covering plans — the plan requires another drug be tried first.
- No prior authorization is filed, but step therapy applies on 724 of 724 covering plans — the plan requires another drug be tried first.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| 24 HR levomilnacipran 120 MG Extended Release Oral Capsule [Fetzima]1433223 | 731 / 731 | 0 | 731 | 731 | No prior authorization |
| 24 HR levomilnacipran 20 MG Extended Release Oral Capsule [Fetzima]1433229 | 731 / 731 | 0 | 731 | 731 | No prior authorization |
| 24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima]1433235 | 731 / 731 | 0 | 731 | 731 | No prior authorization |
| 24 HR levomilnacipran 80 MG Extended Release Oral Capsule [Fetzima]1433241 | 724 / 731 | 0 | 724 | 724 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — 24 HR levomilnacipran 120 MG Extended Release Oral Capsule [Fetzima]
Fetzima has 4 products in the corpus; this table is for 24 HR levomilnacipran 120 MG Extended Release Oral Capsule [Fetzima], 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 Access from UHC AZ-15 (PPO) | H2406-129 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Access from UHC MT-3 (PPO) | H8211-012 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Access from UHC NC-23 (PPO) | H2001-084 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Access from UHC VA-20 (PPO) | H2001-115 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Access from UHC WA-11 (PPO) | H2001-138 | 4 | No | Yes | Yes |
| AARP Medicare Advantage CareFlex from UHC AZ-17 (HMO-POS) | H5253-178 | 4 | No | Yes | Yes |
| AARP Medicare Advantage CareFlex from UHC MA-9 (HMO-POS) | H5253-159 | 4 | No | Yes | Yes |
| AARP Medicare Advantage CareFlex from UHC RI-5 (HMO-POS) | H5253-169 | 4 | No | Yes | Yes |
| AARP Medicare Advantage CareFlex from UHC ST-6 (HMO-POS) | H2802-073 | 4 | No | Yes | Yes |
| AARP Medicare Advantage CareFlex from UHC TX-44 (HMO-POS) | H0609-077 | 4 | No | Yes | Yes |
| AARP Medicare Advantage CareFlex from UHC TX-45 (HMO-POS) | H0609-078 | 4 | No | Yes | Yes |
| AARP Medicare Advantage CareFlex from UHC WI-18 (HMO-POS) | H5253-198 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC AR-1 (HMO-POS) | H2802-060 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC AZ-1 (HMO-POS) | H0609-025 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC AZ-2 (HMO-POS) | H0609-026 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC CO-2 (HMO-POS) | H0609-012 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC CO-4 (HMO-POS) | H0609-036 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC CO-4 (HMO-POS) | H0609-036 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC DE-3 (HMO-POS) | H5253-142 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC EP-1 (PPO) | H2406-039 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC IL-8 (HMO-POS) | H2802-024 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC IN-10 (HMO-POS) | H2802-007 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC IN-11 (HMO-POS) | H2802-008 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC IN-12 (HMO-POS) | H2802-010 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC KC-4 (PPO) | H8768-023 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC KC-6 (HMO-POS) | H2802-076 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC KY-1 (HMO-POS) | H5253-099 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC MO-4 (HMO-POS) | H2802-030 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC NE-3 (HMO-POS) | H2802-001 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC NJ-1 (HMO-POS) | H0755-038 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC OH-2 (HMO-POS) | H5253-062 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) | H5253-144 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) | H5253-144 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC OH-6 (HMO-POS) | H5253-124 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC OH-6 (HMO-POS) | H5253-124 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC OH-7 (HMO-POS) | H5253-125 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC OH-7 (HMO-POS) | H5253-125 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC OK-3 (HMO-POS) | H5253-173 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC OR-4 (HMO-POS) | H3805-039 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC OR-4 (HMO-POS) | H3805-039 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS) | H5253-154 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC ST-3 (HMO-POS) | H2802-028 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC TX-21 (HMO-POS) | H0609-050 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC TX-22 (HMO-POS) | H0609-051 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC TX-26 (HMO-POS) | H0609-060 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC UT-4 (HMO-POS) | H4604-011 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC WA-6 (HMO-POS) | H3805-017 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) | H3805-032 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC WA-8 (HMO-POS) | H3805-033 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS) | H5253-033 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Essentials ValueRx NV-5 (HMO-POS) | H0609-038 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC AR-7 (HMO-POS) | H2802-078 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC AZ-4 (HMO-POS) | H0609-045 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC AZ-5 (HMO-POS) | H0609-046 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC CO-20 (HMO-POS) | H0609-073 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC CO-5 (HMO-POS) | H0609-048 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC DE-6 (HMO-POS) | H5253-206 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC EP-3 (PPO) | H2406-121 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC IL-9 (HMO-POS) | H2802-075 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC IN-16 (HMO-POS) | H2802-055 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC IN-17 (HMO-POS) | H2802-056 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC KC-2 (HMO-POS) | H2802-032 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC KC-5 (PPO) | H8768-039 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC KY-5 (HMO-POS) | H5253-128 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC MO-10 (HMO-POS) | H2802-072 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC NE-5 (HMO-POS) | H2802-074 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC NJ-7 (HMO-POS) | H0755-046 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC OH-10 (HMO-POS) | H5253-131 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC OH-11 (HMO-POS) | H5253-132 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC OH-12 (HMO-POS) | H5253-133 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC OH-13 (HMO-POS) | H5253-134 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC OH-8 (HMO-POS) | H5253-126 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC OH-8 (HMO-POS) | H5253-126 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC OH-9 (HMO-POS) | H5253-130 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC OK-8 (HMO-POS) | H5253-204 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC OR-6 (HMO-POS) | H3805-041 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC PA-18 (HMO-POS) | H5253-203 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC ST-4 (HMO-POS) | H2802-052 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC TX-27 (HMO-POS) | H0609-061 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC TX-28 (HMO-POS) | H0609-063 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC TX-48 (HMO-POS) | H0609-080 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC WA-14 (HMO-POS) | H3805-044 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC WA-15 (HMO-POS) | H3805-045 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras from UHC WI-19 (HMO-POS) | H5253-199 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras UT-7 (HMO-POS) | H4604-018 | 4 | No | Yes | Yes |
| AARP Medicare Advantage Extras ValueRx NV-10 (HMO-POS) | H0609-075 | 4 | No | Yes | Yes |
| AARP Medicare Advantage from UHC AL-0001 (HMO-POS) | H0432-003 | 4 | No | Yes | Yes |
| AARP Medicare Advantage from UHC AL-0002 (HMO-POS) | H0432-004 | 4 | No | Yes | Yes |
| AARP Medicare Advantage from UHC AL-0003 (HMO-POS) | H2802-041 | 4 | No | Yes | Yes |
| AARP Medicare Advantage from UHC AL-0004 (PPO) | H1889-015 | 4 | No | Yes | Yes |
| AARP Medicare Advantage from UHC AL-6 (HMO-POS) | H2802-079 | 4 | No | Yes | Yes |
| AARP Medicare Advantage from UHC AR-0002 (HMO-POS) | H2802-061 | 4 | No | Yes | Yes |
| AARP Medicare Advantage from UHC AR-0004 (PPO) | H1889-014 | 4 | No | Yes | Yes |
| AARP Medicare Advantage from UHC AZ-0003 (HMO-POS) | H0609-044 | 4 | No | Yes | Yes |
| AARP Medicare Advantage from UHC AZ-0007 (PPO) | H2406-062 | 4 | No | Yes | Yes |
| AARP Medicare Advantage from UHC AZ-0008 (PPO) | H2406-063 | 4 | No | Yes | Yes |
| AARP Medicare Advantage from UHC AZ-0010 (PPO) | H2406-076 | 4 | No | Yes | Yes |
| AARP Medicare Advantage from UHC AZ-0011 (PPO) | H2406-078 | 4 | No | Yes | Yes |
| AARP Medicare Advantage from UHC AZ-0013 (HMO-POS) | H5253-035 | 4 | No | Yes | Yes |
| AARP Medicare Advantage from UHC AZ-0014 (HMO-POS) | H5253-036 | 4 | No | Yes | Yes |
Showing 100 of 731 covering plans.
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.
Fetzima 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.