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)|
|Sustol||Aloxi, Zofran, Kytril|
|Epogen/Procrit||Biosimilar epoetin alfa (Retacrit)|
|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|