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 |
| 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 |
| 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 |