With Medicare Advantage plans, some Part B drugs have certain requirements or coverage limits, such as step therapy. Our Part B Step Therapy Program encourages you to try less costly, but just as effective, preferred alternative Part B drugs before the plan covers another drug prescribed by your doctor.

How Part B Step Therapy works

If your doctor prescribes a new drug for you that is listed in the Requested Product column of the table below to treat your medical condition, we may first require you to try one of the drugs included in the Preferred Alternative Agent(s) column. If the Preferred Alternative Agent does not work for you, then we will cover the Requested Product if it meets the medical necessity criteria outlined in our medical policy guidelines. For the purposes of this program, a “new” drug is one that you have not taken for at least 365 days prior to a particular prescription.

If you have questions, please talk to your doctor about this program. Your doctor can access our medical policy guidelines pertaining to a specific drug and then review those guidelines with you.