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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

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