Effective 2019, the Centers for Medicare & Medicaid Services allows health plans to implement a Drug Step Therapy program for certain Part B drugs. 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. The list of Part B drugs that are impacted by Horizon Blue Cross Blue Shield of New Jersey’s Step Therapy program is included below along with the Preferred Alternatives.
| Part B Drugs | Preferred Alternative Drug(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 |