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Part B Step Therapy

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)

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