Step Therapy: In some cases, we require you to first try one drug to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may require your doctor to prescribe Drug A first. If Drug A does not work for you, then we will cover Drug B. This Step Therapy Program encourages Medicare Advantage members to try less costly, but just as effective, Part B drugs before the plan covers another drug. We give you the information you need to take care of your health.
Effective 2019, the list of Part B drugs and Preferred Alternatives below are impacted by Horizon Blue Cross Blue Shield of New Jersey’s Step Therapy program:
| Requested Product | Preferred Alternative Agent(s) |
|---|---|
| Aloxi | Zofran, Kytril |
| Sustol | Aloxi, Zofran, Kytril |
| Epogen/Procrit | Biosimilar epoetin alfa (Retacrit) |
| Neupogen | Granix, Zarxio |
| Fusilev | Leucovorin |
| Tysabri | Multiple Sclerosis: Interferon beta (i.e. Avonoex, Rebif, Betaseron, Extavia), Copaxone Crohn’s Disease: Immunosuppressants (5-ASA, 6-mercaptopurine, azathioprine, cyclosporine, methotrexate), TNF Antagonist |
| Lemtrada | Avonex, Rebif, Betaseron, Extavia, Tysabri, Copaxone, Tysabri, Ocrevus, Tecfidera, Gilenya, Aubagio |
| Vpriv | Cerezyme, Cerdelga |
| Elelyso | Cerezyme, Cerdelga |
| Prolia | Reclast |
| Xgeva | Zometa |
Additional drugs will be added to Horizon Blue Cross Blue Shield of New Jersey's Part B Step Therapy program in 2020. The list below includes all Part B drugs and Preferred Alternatives impacted by Horizon Blue Cross Blue Shield of New Jersey’s Step Therapy program effective February 1, 2020:
| Requested Part B Drug | Preferred Alternative Agent(s) |
|---|---|
| Aloxi | Zofran, Kytril |
| Sustol | Aloxi, Zofran, Kytril |
| Epogen/Procrit | Biosimilar epoetin alfa (Retacrit) |
| Neupogen | Granix, Zarxio |
| Fusilev, Khapzory | Leucovorin |
| Tysabri | Multiple Sclerosis: Interferon beta (i.e. Avonoex, Rebif, Betaseron, Extavia), Copaxone Crohn’s Disease: Immunosuppressants (5-ASA, 6-mercaptopurine, azathioprine, cyclosporine, methotrexate), TNF Antagonist |
| Lemtrada | Avonex, Rebif, Betaseron, Extavia, Tysabri, Copaxone, Tysabri, Ocrevus, Tecfidera, Gilenya, Aubagio |
| Vpriv | Cerezyme, Cerdelga |
| Elelyso | Cerezyme, Cerdelga |
| Prolia | Reclast |
| Xgeva | Zometa |
| Herceptin | Ontruzant, Trazimera, Kanjinti, Herzuma, Ogivri |
| Rituxan | Truxima, Ruxience |
| Avastin | Mvasi, Zirabev |
| Treanda | Bendeka, Belrapzo |
| Soliris | Ultomiris |
| Abraxane | Paclitaxel (for off-label uses only) |