Prior authorization required

Does Wellpoint Tennessee, INC. require prior authorization for Piqray 200 MG Daily Dose?

Wellpoint Tennessee, INC. requires prior authorization for Piqray 200 MG Daily Dose 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
{28 (alpelisib 200 MG Oral Tablet [Piqray]) } Pack [Piqray 200 MG Daily Dose]2169314	9 / 9	9	0	9	Prior authorization required

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

Plan-by-plan detail — {28 (alpelisib 200 MG Oral Tablet [Piqray]) } Pack [Piqray 200 MG Daily Dose]

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
Wellpoint Extra Help (HMO-POS)	H5828-008	5	Yes	No	Yes
Wellpoint Full Dual Advantage (HMO D-SNP)	H5828-002	5	Yes	No	Yes
Wellpoint Full Dual Advantage 2 (HMO D-SNP)	H5828-018	5	Yes	No	Yes
Wellpoint Full Dual Advantage Support (HMO D-SNP)	H5828-001	5	Yes	No	Yes
Wellpoint Medicare Advantage (HMO-POS)	H5828-013	5	Yes	No	Yes
Wellpoint Medicare Advantage 2 (HMO-POS)	H5828-014	5	Yes	No	Yes
Wellpoint Medicare Advantage 2 (HMO-POS)	H5828-015	5	Yes	No	Yes
Wellpoint Medicare Advantage 2 (HMO-POS)	H5828-016	5	Yes	No	Yes
Wellpoint Medicare Advantage 2 (HMO-POS)	H5828-017	5	Yes	No	Yes

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.

Piqray 200 MG Daily Dose at other payers

Or see Piqray 200 MG Daily Dose 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.