Does Anthem (Elevance Health) Cover Finasteride?

The two products a drug list would show

Propecia is the 1 mg tablet, NDA 020788, first approved 12/19/1997 as a new dosage form [2]. Its label covers male pattern hair loss (androgenetic alopecia) in men only; efficacy in bitemporal recession has not been established and it is not indicated for women [2][4].

Proscar is the 5 mg tablet, NDA 020180, approved 06/19/1992 for symptomatic benign prostatic hyperplasia in men with an enlarged prostate: it improves symptoms and reduces the risk of acute urinary retention and of surgery, and it is not approved to prevent prostate cancer [3][6].

Generic 1 mg and 5 mg finasteride tablets are FDA-approved and carry the same labeled risks as the brands.

Does the federal prior authorization rule decide this?

The CMS Interoperability and Prior Authorization final rule (CMS-0057-F) applies to Medicare Advantage organizations and Medicaid managed care plans, among other payers, but it addresses prior authorization data exchange rather than which drugs a plan covers, and its data provisions exclude prior authorizations for drugs [1]. Commercial employer group plans are not among the payer types it names [1]. Whether finasteride 1 mg or 5 mg is listed depends on the specific plan's current drug list.

What the labels say about the drug itself

There is no boxed warning on Propecia or Proscar [4][6]. Their postmarketing sections list depression, suicidal ideation and behavior, and sexual dysfunction that continued after stopping treatment, with the labels' caveat that these are voluntary reports from a population of uncertain size and that a causal relationship cannot reliably be established [4][6]; the 2022 Propecia wording change followed an FDA order [5]. Finasteride is contraindicated in pregnancy, and women who are or may be pregnant should not handle crushed or broken tablets; intact coated tablets prevent contact with the active ingredient [4].

How to check your own coverage

• Search the drug list under each strength separately: finasteride 1 mg and finasteride 5 mg.
• Note any prior authorization, quantity limit or step requirement flagged next to the entry.