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Does Medicare Part D cover Caplyta?

Caplyta appears on the Medicare Part D formularies of 317 payers in the corpus. 112 require prior authorization on every covering plan, 4 on some plans, and 201 on none.

Prior authorization is set per plan, not per payer. Pick a payer below for its full plan-by-plan breakdown, effective 2026-06-30.

Coverage by payer

PayerPlans coveringRequire prior authStatus
Humana817817Prior authorization required
UnitedHealthcare7310No prior authorization
Aetna (CVS Health)65815Varies by plan
Devoted Health4150No prior authorization
Blue Cross Blue Shield (affiliate)26999Varies by plan
Centene (WellCare)1970No prior authorization
Cigna1710No prior authorization
Kaiser Permanente11516Varies by plan
SCAN Health Plan7474Prior authorization required
Elevance Health (Anthem)670No prior authorization
Alignment Healthcare670No prior authorization
Medco Containment Life And Medco Containment Ny600No prior authorization
Molina Healthcare510No prior authorization
Simply Healthcare Plans, INC.500No prior authorization
Cariten Health Plan INC.4444Prior authorization required
Uhc Of California400No prior authorization
Priority Health3737Prior authorization required
Careplus Health Plans, INC.3636Prior authorization required
Bravo Health Pennsylvania, INC.350No prior authorization
Preferred Care Partners, INC.350No prior authorization
Zing Health Of Michigan, INC.330No prior authorization
Health Care Service Corporation310No prior authorization
Solis Health Plans, INC.240No prior authorization
Sunshine State Health Plan, INC.240No prior authorization
Freedom Health, INC.240No prior authorization
Capital Advantage Insurance Company230No prior authorization
Triple S Advantage, INC.220No prior authorization
Physicians Health Choice Of Texas, LLC220No prior authorization
Tufts Associated Health Maintenance Organization2121Prior authorization required
Mmm Healthcare, LLC2020Prior authorization required
Mcs Advantage, INC.2020Prior authorization required
Harmony Health Plan, INC.190No prior authorization
Hcsc Insurance Services Company180No prior authorization
California Physicians' Service1717Prior authorization required
Medica Health Plans170No prior authorization
Upmc Health Plan, INC.1717Prior authorization required
Bluecross Blueshield Of Tennessee, INC.170No prior authorization
Wellpoint Texas, INC.160No prior authorization
Ultimate Health Plans, INC.1616Prior authorization required
Excellus Health Plan, INC.1616Prior authorization required
Medical Mutual Of Ohio160No prior authorization
Superior Healthplan, INC.150No prior authorization
Florida Blue Medicare, INC.152Varies by plan
Optimum Healthcare, INC.150No prior authorization
Central Health Plan Of California, INC.150No prior authorization
Blue Care Network Of Michigan150No prior authorization
Selecthealth, INC.1414Prior authorization required
Wellpoint Insurance Company140No prior authorization
Peoples Health, INC.130No prior authorization
Clover Health130No prior authorization
Healthsun Health Plans, INC.130No prior authorization
Prominence Healthfirst Of Texas130No prior authorization
Atrio Health Plans120No prior authorization
Upmc Health Network, INC.1212Prior authorization required
HMO Louisiana, INC.120No prior authorization
Mount Carmel Health Plan, INC.110No prior authorization
Pacificsource Community Health Plans110No prior authorization
Community Insurance Company100No prior authorization
Health Insurance Plan Of Greater New York100No prior authorization
HMO Colorado, INC.100No prior authorization
Quartz Health Plan Corporation1010Prior authorization required
Compcare Health Services Insurance Corporation100No prior authorization
Sanford Health Plan99Prior authorization required
Allina Health And Aetna Insurance Company90No prior authorization
Geisinger Health Plan99Prior authorization required
Doctors Healthcare Plans, INC.90No prior authorization
New York Quality Healthcare Corporation90No prior authorization
Wellpoint Tennessee, INC.90No prior authorization
Healthier New Jersey Insurance Company80No prior authorization
Meridian Health Plan Of Michigan, INC.80No prior authorization
Healthpartners, INC.88Prior authorization required
American Progressive Life & Hlth Ins Company Of Ny80No prior authorization
Mvp Health Plan, INC.80No prior authorization
Keystone Health Plan East, INC.88Prior authorization required
Network Health Insurance Corporation88Prior authorization required
Prominence Healthfirst80No prior authorization
Fallon Community Health Plan80No prior authorization
Peak Health Insurance Corporation88Prior authorization required
Health Partners Plans, INC.80No prior authorization
Medco Containment Life & Medco Containment Ny & Health Care80No prior authorization
Viva Health, INC.70No prior authorization
Martin'S Point Generations Advantage, INC.70No prior authorization
Wellpoint Health Plans, INC.70No prior authorization
Astiva Health, INC.70No prior authorization
Bravo Health Mid-Atlantic, INC.70No prior authorization
Health Alliance Plan Of Michigan77Prior authorization required
Medica Insurance Company70No prior authorization
Summacare INC.70No prior authorization
Keystone Health Plan Central, INC.70No prior authorization
Champion Health Plan Of California INC70No prior authorization
Essence Healthcare PPO, INC.70No prior authorization
Champion Health Plan Of Nevada, INC.70No prior authorization
Bluecross And Blueshield Of South Carolina77Prior authorization required
Providence Health Assurance77Prior authorization required
Alterwood Advantage, INC.70No prior authorization
Mass General Brigham Health Plan, INC66Prior authorization required
Buckeye Community Health Plan, INC.60No prior authorization
Christus Health Plan60No prior authorization
Nebraska Total Care, INC.60No prior authorization
Gold Kidney Of Florida INC60No prior authorization
Essence Healthcare, INC.60No prior authorization
Hometown Health Plan, INC.66Prior authorization required
Presbyterian Health Plan66Prior authorization required
Elderplan, INC.60No prior authorization
Perennial Advantage Of Colorado, INC.66Prior authorization required
Connecticare, INC.60No prior authorization
Globalhealth, INC.60No prior authorization
Preferred Care Network, INC.60No prior authorization
Scott And White Health Plan60No prior authorization
Coordinated Care Of Washington, INC.50No prior authorization
Chinese Community Health Plan50No prior authorization
Hopkins Health Advantage, INC.50No prior authorization
Alliance Health And Life Insurance Company55Prior authorization required
Sapphire Edge, INC.50No prior authorization
Independent Health Association, INC.55Prior authorization required
Coordinated Care Corporation50No prior authorization
Oh Chs Snp INC.50No prior authorization
Usable Mutual Insurance Company50No prior authorization
Gold Kidney Of Arizona50No prior authorization
Meridian Health Plan Of Illinois, INC.50No prior authorization
Sunflower State Health Plan, INC.50No prior authorization
Prominence Healthfirst Of Florida INC50No prior authorization
Priority Health Choice, INC.55Prior authorization required
Arkansas Health & Wellness Health Plan, INC.50No prior authorization
Hpmp Of Florida, INC.50No prior authorization
Home State Health Plan, INC.40No prior authorization
Baylor Scott & White Insurance Company40No prior authorization
Care N' Care Insurance Company Of North Carolina44Prior authorization required
Health New England, INC.40No prior authorization
Pennsylvania Health & Wellness, INC.40No prior authorization
The Health Plan Of West Virginia, INC.40No prior authorization
Communitycare Government Programs, INC.44Prior authorization required
Hawaii Medical Service Association40No prior authorization
Qcc Insurance Company44Prior authorization required
Leon Health, INC.40No prior authorization
Verda Health Plan Of Texas INC40No prior authorization
Security Health Plan Of Wisconsin, INC.44Prior authorization required
Sharp Health Plan40No prior authorization
Gateway Health Plan, INC.44Prior authorization required
Capital Health Plan40No prior authorization
Boston Medical Center Health Plan, INC.40No prior authorization
Bluecross Blueshield Kansas Solutions, INC.40No prior authorization
Clever Care Of Golden State, INC.40No prior authorization
Central Mass Health, LLC40No prior authorization
Ghs Insurance Company40No prior authorization
Thp Insurance Company40No prior authorization
Aspire Health Plan40No prior authorization
Amh Health, LLC40No prior authorization
Dean Health Plan, INC.44Prior authorization required
Quartz Health Plan Mn Corporation44Prior authorization required
Medisun, INC.33Prior authorization required
Metroplus Health Plan, INC.30No prior authorization
Wellpoint West Virginia , INC.30No prior authorization
Louisiana Health Service & Indemnity Company30No prior authorization
Eternalhealth, INC.33Prior authorization required
Patrius Health, INC.30No prior authorization
Marquis Advantage, INC.33Prior authorization required
Partners Insurance Company INC30No prior authorization
Mount Carmel Health Insurance Company30No prior authorization
Community Care Health Plan Of Louisiana, INC.30No prior authorization
Village Senior Services Corporation30No prior authorization
Trillium Community Health Plan, INC.30No prior authorization
Senior Whole Health, LLC30No prior authorization
Baycare Select Health Plans, INC.30No prior authorization
Cox Health Systems HMO INC30No prior authorization
Secur INC33Prior authorization required
Wellpoint New Jersey, INC.30No prior authorization
Volunteer State Health Plan30No prior authorization
Align Senior Care California INC.33Prior authorization required
Pruitthealth Premier, INC.33Prior authorization required
Capital District Physicians' Health Plan, INC.33Prior authorization required
Procare Advantage, LLC33Prior authorization required
Eternalhealth Of Arizona INC33Prior authorization required
Paramount Care, INC.30No prior authorization
Aultcare Health Insuring Corporation33Prior authorization required
Mount Carmel Health Plan Of Idaho, INC.30No prior authorization
Geisinger Indemnity Insurance Company33Prior authorization required
Simpra Advantage, INC.33Prior authorization required
Provider Partners Health Plan Of Pennsylvania, INC33Prior authorization required
Provider Partners Health Plan Of North Carolina33Prior authorization required
Provider Partners Health Plan Of Indiana33Prior authorization required
Celtic Insurance Company30No prior authorization
Amerihealth Insurance Company Of New Jersey33Prior authorization required
Vns Choice30No prior authorization
Mercy Care30No prior authorization
Usable HMO, INC.30No prior authorization
Mclaren Health Plan, INC.30No prior authorization
Liberty Advantage, LLC33Prior authorization required
Southeastern Indiana Health Organization, INC.30No prior authorization
Managed Health Services Insurance CORP.30No prior authorization
Perennial Advantage Of Ohio, INC.33Prior authorization required
Provider Partners Health Plan Of Missouri, INC.33Prior authorization required
Hamaspik, INC.20No prior authorization
Arizona Physicians Ipa, INC.20No prior authorization
Ks Plan Administrators, LLC22Prior authorization required
Carepartners Of Connecticut, INC.22Prior authorization required
Amerihealth Caritas Vip Next, INC.22Prior authorization required
Beshp, INC.22Prior authorization required
Wellpoint Iowa, INC.20No prior authorization
Commonwealth Care Alliance, INC.20No prior authorization
Arkansas Superior Select, INC.20No prior authorization
Wellpoint Washington, INC.20No prior authorization
Neighborhood Health Plan Of Rhode Island20No prior authorization
Lifeworks Advantage, LLC22Prior authorization required
Kansas Superior Select, INC.22Prior authorization required
Signature Advantage, LLC20No prior authorization
Primewest Rural Mn Health Care Access Initiative20No prior authorization
South Country Health Alliance22Prior authorization required
Sentara Health Plans22Prior authorization required
Verda Health Plan Of Arizona, INC.20No prior authorization
Partners Insurance Company Of New Jersey INC20No prior authorization
Sanford Health Plan Of Minnesota22Prior authorization required
Nhc Advantage, LLC22Prior authorization required
Vista Health Plan, INC.22Prior authorization required
American Health Plan Of Ut, INC.22Prior authorization required
Upmc For You, INC22Prior authorization required
American Health Plan Of Missouri, INC.22Prior authorization required
Selectcare Of Texas, INC.20No prior authorization
New Century Health Plan, INC.20No prior authorization
Troy Health, INC.22Prior authorization required
Community Health Group20No prior authorization
Banner - University Care Advantage20No prior authorization
Texas Independence Health Plan, INC.20No prior authorization
Tufts Health Public Plans, INC.22Prior authorization required
Imperial Health Plan Of California, INC.20No prior authorization
Bridgeway Health Solutions Of Arizona, INC.20No prior authorization
Denver Health Medical Plan, INC.20No prior authorization
Community Health Plan Of Washington20No prior authorization
Senior Whole Health Of New York, INC.20No prior authorization
Nextblue Of North Dakota Insurance Company20No prior authorization
Healthpartners Insurance Company22Prior authorization required
Missouri Care, Incorporated20No prior authorization
Pruitthealth Premier North Carolina, LLC22Prior authorization required
Elite Health Plan, INC.20No prior authorization
American Health Plan Of Iowa INC22Prior authorization required
Elderserve Health, INC.20No prior authorization
Align Senior Care Mi, LLC22Prior authorization required
Isnp Ventures, LLC22Prior authorization required
Memorial Hermann Health Plan20No prior authorization
Good Samaritan Insurance Plan Of Nebraska, INC.22Prior authorization required
Excellus Health Plan Community Care LLC22Prior authorization required
Group Health Cooperative Of Eau Claire20No prior authorization
Georgia Assurance, INC.22Prior authorization required
Caresource Georgia CO.20No prior authorization
Visiting Nurse Association Of Central New York20No prior authorization
Trinity Health Plan Of Michigan INC20No prior authorization
Wyoblue Advantage INC20No prior authorization
Community Health Choice Texas, INC.22Prior authorization required
Mount Carmel Health Plan Of New York, INC.20No prior authorization
Align Senior Care Florida, INC.22Prior authorization required
Longevity Health Plan Of New Jersey Insurance Comp20No prior authorization
Hm Health Insurance Company22Prior authorization required
Horizon Insurance Company20No prior authorization
Longevity Health Plan Of Colorado, INC.10No prior authorization
Tsg Guard, INC.10No prior authorization
Local Initiative Health Authority For La County11Prior authorization required
Johns Hopkins Health Plan Of Virginia, INC.10No prior authorization
Longevity Health Plan Of Florida, INC.10No prior authorization
Imperial County Local Health Authority10No prior authorization
Community Care Health Plan, INC.10No prior authorization
Alameda Alliance For Health11Prior authorization required
Independent Care Health Plan11Prior authorization required
Itasca Medical Care10No prior authorization
HMO Minnesota10No prior authorization
Amerihealth Caritas Louisiana, INC.11Prior authorization required
Wellpoint South Carolina, INC.10No prior authorization
Upper Peninsula Health Plan, LLC10No prior authorization
Connecticare Insurance Company, INC.10No prior authorization
Independent Health Benefits Corporation11Prior authorization required
Oklahoma Superior Select, INC.11Prior authorization required
Provider Partners Health Plan Of Illinois11Prior authorization required
Allcare Health Plan, INC.10No prior authorization
Samaritan Health Plans, INC.11Prior authorization required
Ghs Health Maintenance Organization, INC.10No prior authorization
Santa Clara County Health Authority10No prior authorization
Provider Partners Health Plan Of Texas, INC.11Prior authorization required
Kern Health Systems10No prior authorization
Hap Caresource10No prior authorization
Select Health Of South Carolina, INC.11Prior authorization required
Contra Costa County Medical Service Dba Contra Costa Health11Prior authorization required
Paramount Insurance Company10No prior authorization
Absolute Total Care, INC.10No prior authorization
Longevity Health Plan Of North Carolina, INC.10No prior authorization
Orange County Health Authority11Prior authorization required
Health Choice Arizona, INC.10No prior authorization
Santa Cruz Monterey Merced San Benito Mariposa Managed Medic10No prior authorization
San Joaquin County Health Commission10No prior authorization
Banner Health Plan, INC.10No prior authorization
Aids Healthcare Foundation10No prior authorization
Health Plan Of Careoregon, INC.11Prior authorization required
Alohacare11Prior authorization required
San Mateo Health Commission11Prior authorization required
Amerihealth Michigan, INC.11Prior authorization required
Amerihealth Caritas Florida, INC.11Prior authorization required
Caresource Ohio, INC.10No prior authorization
Lagniappe Advantage Insurance Company11Prior authorization required
American Health Plan Of Fl, INC.11Prior authorization required
Upmc Health Coverage, INC.11Prior authorization required
Provider Partners Health Plan Of Kentucky11Prior authorization required
Longevity Health Plan Of Michigan, INC.10No prior authorization
Santa Barbara San Luis Obispo Regional Health Authority Dba10No prior authorization
American Health Plan, INC.11Prior authorization required
San Francisco Health Authority Dba San Francisco Health Plan10No prior authorization
Amerihealth Caritas North Carolina, INC.11Prior authorization required
Horizon Healthcare Of New Jersey, INC.10No prior authorization
Longevity Health Plan Of New York, INC.10No prior authorization
Hawaii Medical Service Association (Hmsa)10No prior authorization
Dignity Care Corporation11Prior authorization required
Healthy Mississippi, INC.11Prior authorization required
Inland Empire Health Plan10No prior authorization
West Virginia Senior Advantage, INC.10No prior authorization
Longevity Health Plan Of Illinois, INC.10No prior authorization
Ventura County Medi-Cal Managed Care Commission10No prior authorization
Healthfirst Insurance Company, INC.10No prior authorization
American Health Plan Of Indiana INC11Prior authorization required
American Health Plan Of Ms, INC.11Prior authorization required
American Health Plan Of Pennsylvania INC11Prior authorization required

“Require prior auth” counts a plan when any Caplyta product on its formulary needs authorization.

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.

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.