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Part B 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.

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) Included in the program beginning
Abraxane® Paclitaxel (off-label uses only) January 1, 2021
Aloxi Zofran, Kytril January 1, 2019
Asceniv™ Bivigam®, Carimune® NF, Flebogamma®, Flebogamma® DIF, Gammagard Liquid®, Gammaked™, Gammaplex®, Gamunex®-C, Octagam®, Panzyga®, Privigen® January 1, 2022
Avastin® Mvasi™, Zirabev® January 1, 2021
Elelyso Cerezyme, Cerdelga January 1, 2019
Epogen/Procrit Biosimilar epoetin alfa (Retacrit) January 1, 2019
Fusilev Leucovorin January 1, 2019
Fusilev®, Khapzory™ leucovorin January 1, 2021
Herceptin® Kanjinti™, Ogivri™, Trazimera™ January 1, 2021
Herzuma® Kanjinti™, Ogivri™, Trazimera™ January 1, 2021
Infugem™ gemcitabine January 1, 2021
Lemtrada Avonex, Rebif, Betaseron, Extavia, Tysabri, Copaxone, Tysabri, Ocrevus, Tecfidera, Gilenya, Aubagio January 1, 2019
Marqibo® vincristine sulfate October 15, 2021
Neupogen Granix, Zarxio January 1, 2019
Ontruzant® Kanjinti™, Ogivri™, Trazimera™ January 1, 2021
Prolia Reclast January 1, 2019
Rituxan® Truxima®, Ruxience® January 1, 2021
Soliris® Ultomiris® January 1, 2021
Sustol Aloxi, Zofran, Kytril January 1, 2019
Treanda® Bendeka®, Belrapzo™ January 1, 2021
Tysabri For Multiple Sclerosis: Interferon beta (i.e. Avonoex, Rebif, Betaseron, Extavia), Copaxone
For Crohn’s Disease: Immunosuppressants (5-ASA, 6-mercaptopurine, azathioprine, cyclosporine, methotrexate), TNF Antagonist
January 1, 2019
Vpriv Cerezyme, Cerdelga January 1, 2019
Xgeva Zometa January 1, 2019
Ziextenzo® Neulasta®, Fulphila®, Udencya® January 1, 2021

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