What is Medicare Part B Step Therapy?
■ Starting in 2021, some medically administered Part B drugs, like injectables or biologics, may have special requirements or coverage limits, such as step therapy.
■ Step therapy requires a trial of a preferred drug to treat a medical condition before covering a non-preferred drug.
o Here’s an example: Drug A (preferred) and Drug B (non-preferred) are both used to treat the same medical condition. We may require that you try Drug A (preferred) first. If Drug A does not work, we’ll then cover Drug B (non-preferred).
■ The step therapy requirement does not apply to members who have already received treatment with the non-preferred drug within the past 365 days.
■ Both preferred and non-preferred drugs may still be subject to prior authorization or quantity limits.
Click Here to Download the Medicare Part B Step Therapy Drug List.