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Does Medicare Part D cover Lybalvi?

Lybalvi appears on the Medicare Part D formularies of 190 payers in the corpus. 77 require prior authorization on every covering plan, 1 on some plans, and 112 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
Devoted Health4150No prior authorization
Kaiser Permanente1150No prior authorization
Blue Cross Blue Shield (affiliate)9377Varies by plan
Alignment Healthcare6767Prior authorization required
Molina Healthcare510No prior authorization
Simply Healthcare Plans, INC.5050Prior authorization required
Cariten Health Plan INC.4444Prior authorization required
Careplus Health Plans, INC.3636Prior authorization required
Zing Health Of Michigan, INC.330No prior authorization
Health Care Service Corporation3131Prior authorization required
Solis Health Plans, INC.2424Prior authorization required
Freedom Health, INC.2424Prior authorization required
Tufts Associated Health Maintenance Organization2121Prior authorization required
Mcs Advantage, INC.2020Prior authorization required
Hcsc Insurance Services Company1818Prior authorization required
Ultimate Health Plans, INC.160No prior authorization
Excellus Health Plan, INC.1616Prior authorization required
Florida Blue Medicare, INC.1515Prior authorization required
Optimum Healthcare, INC.1515Prior authorization required
Central Health Plan Of California, INC.150No prior authorization
Selecthealth, INC.1414Prior authorization required
Clover Health130No prior authorization
Healthsun Health Plans, INC.1313Prior authorization required
Prominence Healthfirst Of Texas1313Prior authorization required
Atrio Health Plans120No prior authorization
Mount Carmel Health Plan, INC.110No prior authorization
Pacificsource Community Health Plans110No prior authorization
Health Insurance Plan Of Greater New York1010Prior authorization required
Quartz Health Plan Corporation100No prior authorization
Sanford Health Plan90No prior authorization
Geisinger Health Plan99Prior authorization required
Doctors Healthcare Plans, INC.99Prior authorization required
Healthier New Jersey Insurance Company88Prior authorization required
Healthpartners, INC.88Prior authorization required
Mvp Health Plan, INC.80No prior authorization
Keystone Health Plan East, INC.88Prior authorization required
Network Health Insurance Corporation80No prior authorization
Prominence Healthfirst88Prior authorization required
Fallon Community Health Plan80No prior authorization
Medco Containment Life & Medco Containment Ny & Health Care88Prior authorization required
Viva Health, INC.70No prior authorization
Martin'S Point Generations Advantage, INC.70No prior authorization
Aetna (CVS Health)70No prior authorization
Astiva Health, INC.70No prior authorization
Health Alliance Plan Of Michigan77Prior authorization required
Summacare INC.70No prior authorization
Champion Health Plan Of California INC70No prior authorization
Champion Health Plan Of Nevada, INC.70No prior authorization
Bluecross And Blueshield Of South Carolina70No prior authorization
Providence Health Assurance77Prior authorization required
Alterwood Advantage, INC.70No prior authorization
Mass General Brigham Health Plan, INC66Prior authorization required
Christus Health Plan60No prior authorization
Gold Kidney Of Florida INC60No prior authorization
Hometown Health Plan, INC.60No prior authorization
Presbyterian Health Plan66Prior authorization required
Elderplan, INC.60No prior authorization
Connecticare, INC.60No prior authorization
Globalhealth, INC.60No prior authorization
Scott And White Health Plan66Prior authorization required
Chinese Community Health Plan50No prior authorization
Hopkins Health Advantage, INC.50No prior authorization
Alliance Health And Life Insurance Company55Prior authorization required
Sapphire Edge, INC.55Prior authorization required
Independent Health Association, INC.55Prior authorization required
Oh Chs Snp INC.50No prior authorization
Usable Mutual Insurance Company50No prior authorization
Gold Kidney Of Arizona50No prior authorization
Prominence Healthfirst Of Florida INC55Prior authorization required
Hpmp Of Florida, INC.50No prior authorization
Baylor Scott & White Insurance Company44Prior authorization required
Care N' Care Insurance Company Of North Carolina40No prior authorization
Health New England, INC.40No prior authorization
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.40No prior authorization
Sharp Health Plan40No prior authorization
Gateway Health Plan, INC.44Prior authorization required
Capital Health Plan44Prior authorization required
Bluecross Blueshield Kansas Solutions, INC.44Prior authorization required
Clever Care Of Golden State, INC.40No prior authorization
Central Mass Health, LLC44Prior authorization required
Ghs Insurance Company44Prior authorization required
Aspire Health Plan40No prior authorization
Quartz Health Plan Mn Corporation40No prior authorization
Medisun, INC.30No prior authorization
Metroplus Health Plan, INC.30No prior authorization
Eternalhealth, INC.30No prior authorization
Patrius Health, INC.33Prior authorization required
Mount Carmel Health Insurance Company30No prior authorization
Village Senior Services Corporation30No prior authorization
Senior Whole Health, LLC30No prior authorization
Baycare Select Health Plans, INC.30No prior authorization
Cox Health Systems HMO INC30No prior authorization
Capital District Physicians' Health Plan, INC.33Prior authorization required
Eternalhealth Of Arizona INC30No prior authorization
Paramount Care, INC.30No prior authorization
Aultcare Health Insuring Corporation30No prior authorization
Mount Carmel Health Plan Of Idaho, INC.30No prior authorization
Geisinger Indemnity Insurance Company33Prior authorization required
Provider Partners Health Plan Of Pennsylvania, INC30No prior authorization
Provider Partners Health Plan Of North Carolina30No prior authorization
Provider Partners Health Plan Of Indiana30No 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
Southeastern Indiana Health Organization, INC.30No prior authorization
Provider Partners Health Plan Of Missouri, INC.30No prior authorization
Hamaspik, INC.22Prior authorization required
Ks Plan Administrators, LLC20No prior authorization
Carepartners Of Connecticut, INC.22Prior authorization required
Amerihealth Caritas Vip Next, INC.22Prior authorization required
Beshp, INC.20No prior authorization
Commonwealth Care Alliance, INC.20No prior authorization
Arkansas Superior Select, INC.20No prior authorization
Neighborhood Health Plan Of Rhode Island20No prior authorization
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
Sanford Health Plan Of Minnesota20No prior authorization
Capital Advantage Insurance Company22Prior authorization required
Keystone Health Plan Central, INC.22Prior authorization required
Vista Health Plan, INC.22Prior authorization required
New Century Health Plan, INC.20No prior authorization
Troy Health, INC.22Prior authorization required
Community Health Group20No 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
Denver Health Medical Plan, INC.20No prior authorization
Senior Whole Health Of New York, INC.20No prior authorization
Healthpartners Insurance Company22Prior authorization required
Elite Health Plan, INC.20No prior authorization
Memorial Hermann Health Plan22Prior authorization required
Good Samaritan Insurance Plan Of Nebraska, INC.20No prior authorization
Excellus Health Plan Community Care LLC22Prior authorization required
Visiting Nurse Association Of Central New York20No prior authorization
Trinity Health Plan Of Michigan INC20No prior authorization
Mount Carmel Health Plan Of New York, INC.20No prior authorization
Elevance Health (Anthem)20No prior authorization
Horizon Insurance Company22Prior authorization required
Tsg Guard, INC.10No prior authorization
Johns Hopkins Health Plan Of Virginia, 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 Minnesota11Prior authorization required
Amerihealth Caritas Louisiana, INC.11Prior authorization required
Connecticare Insurance Company, INC.10No prior authorization
Independent Health Benefits Corporation11Prior authorization required
Provider Partners Health Plan Of Illinois10No prior authorization
Allcare Health Plan, INC.10No prior authorization
Samaritan Health Plans, INC.10No prior authorization
Ghs Health Maintenance Organization, INC.11Prior authorization required
Santa Clara County Health Authority10No prior authorization
Provider Partners Health Plan Of Texas, INC.10No prior authorization
Kern Health Systems10No 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
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
Aids Healthcare Foundation10No prior authorization
Health Plan Of Careoregon, INC.11Prior authorization required
Alohacare10No prior authorization
San Mateo Health Commission11Prior authorization required
Amerihealth Michigan, INC.11Prior authorization required
Amerihealth Caritas Florida, INC.11Prior authorization required
Provider Partners Health Plan Of Kentucky10No prior authorization
Santa Barbara San Luis Obispo Regional Health Authority Dba10No prior authorization
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.11Prior authorization required
Hawaii Medical Service Association (Hmsa)10No prior authorization
Healthy Mississippi, INC.11Prior authorization required
Inland Empire Health Plan11Prior authorization required
West Virginia Senior Advantage, INC.10No prior authorization
Ventura County Medi-Cal Managed Care Commission11Prior authorization required
Healthfirst Insurance Company, INC.10No prior authorization

“Require prior auth” counts a plan when any Lybalvi 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.