Does Wellpoint Tennessee, INC. require prior authorization for Cystagon?
Wellpoint Tennessee, INC. requires prior authorization for Cystagon 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 |
|---|---|---|---|---|---|
| cysteamine 150 MG Oral Capsule [Cystagon]209788 | 9 / 9 | 9 | 0 | 0 | Prior authorization required |
| cysteamine 50 MG Oral Capsule [Cystagon]209789 | 9 / 9 | 9 | 0 | 0 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — cysteamine 150 MG Oral Capsule [Cystagon]
Cystagon has 2 products in the corpus; this table is for cysteamine 150 MG Oral Capsule [Cystagon], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Wellpoint Extra Help (HMO-POS) | H5828-008 | 3 | Yes | No | No |
| Wellpoint Full Dual Advantage (HMO D-SNP) | H5828-002 | 3 | Yes | No | No |
| Wellpoint Full Dual Advantage 2 (HMO D-SNP) | H5828-018 | 3 | Yes | No | No |
| Wellpoint Full Dual Advantage Support (HMO D-SNP) | H5828-001 | 3 | Yes | No | No |
| Wellpoint Medicare Advantage (HMO-POS) | H5828-013 | 3 | Yes | No | No |
| Wellpoint Medicare Advantage 2 (HMO-POS) | H5828-014 | 4 | Yes | No | No |
| Wellpoint Medicare Advantage 2 (HMO-POS) | H5828-015 | 4 | Yes | No | No |
| Wellpoint Medicare Advantage 2 (HMO-POS) | H5828-016 | 4 | Yes | No | No |
| Wellpoint Medicare Advantage 2 (HMO-POS) | H5828-017 | 4 | Yes | 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.
Cystagon 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.