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2021 Step Therapy List for Medicare Part B Drugs

Starting January 1, 2021, we'll require step therapy on several types of Medicare Part B drugs. Here's a closer look at how step therapy works and which drugs require it. To learn more about step therapy and other rules for Part B and Part D drugs, check our drug coverage limits page.

How Step Therapy Works

In the list below, you'll see drugs labeled as either Step 1 or Step 2. Step 2 drugs are the ones that require step therapy. Before you can get them, you have to first try a Step 1 drug.

Step 1 drugs usually require prior authorization. That means before you can take this drug, your doctor has to send us information that explains why you need it. If a Step 1 drug doesn't require prior authorization, we tell you in the list below.

Step 2 drugs always require prior authorization. Your doctor also needs to let us know one of the following:

  • Why the Step 1 drug didn’t work for you or why you can’t take the Step 1 drug
  • Why the Step 1 drug is best for your needs
  • Details from your doctor to show that you've taken the Step 2 drug in the past 365 days

Acromegaly Drugs

Step 1

  • Somatuline Depot (lanreotide)

Step 2

  • Sandostatin LAR (octreotide acetate for injectable suspension)
  • Signifor LAR (pasireotide)
  • Somavert (pegvisomant)

Alpha1-Proteinase Inhibitors

Step 1

  • Prolastin-C (alpha1-proteinase inhibitor [human])

Step 2

  • Aralast NP (alpha1-proteinase inhibitor [human])
  • Glassia (alpha1-proteinase inhibitor [human])
  • Zemaira (alpha1-proteinase inhibitor [human])

Bevacizumab

These drugs require prior authorization only when used for oncology (to treat cancer).

Step 1

  • Mvasi (bevacizumab-awwb)
  • Zirabev (bevacizumab-bvzr)

Step 2

  • Avastin (bevacizumab)

Botulinum Toxins

Step 1

  • Dysport (abobotulinumtoxinA)
  • Xeomin (incobotulinumtoxinA)

Step 2

  • Botox (onabotulinumtoxinA)
  • Myobloc (rimabotulinumtoxinB)

Colony Stimulating Factors – Long Acting

Step 1

  • Fulphila (pegfilgrastim-jmdb)
  • Udenyca (pegfilgrastim-cbqv)
  • Ziextenzo (pegfilgrastim-bmez)

Step 2

  • Neulasta (pegfilgrastim) syringe for manual injection

Colony Stimulating Factors – Short Acting

Step 1

  • Nivestym (filgrastim-aafi), doesn't require prior authorization
  • Zarxio (filgrastim-sndz), doesn't require prior authorization

Step 2

  • Granix (TBO-filgrastim)
  • Leukine (sargramostim)
  • Neupogen (filgrastim)

Disease-Modifying Antirheumatic Drugs

Step 1

  • Avsola (infliximab-axxq)
  • Entyvio (vedolizumab)
  • Ilumya (tildrakizumab-asmn)
  • Inflectra (infliximab-dyyb)
  • Renflexis(infliximab-abda)
  • Simponi Aria (golimumab, intravenous)
  • Stelara IV (ustekinumab)

Step 2

  • Actemra (tocilizumab)
  • Cimzia (certolizumab pegol)
  • Orencia (abatacept)
  • Remicade (infliximab)

Erythropoiesis Stimulating Drugs

Step 1

  • Aranesp (darbepoetin alfa), doesn't require prior authorization
  • Retacrit (epoetin alfa), doesn't require prior authorization

Step 2

  • Epogen (epoetin alfa)
  • Mircera (methoxy polyethylene glycol-epoetin beta)
  • Procrit (epoetin alfa)

Gaucher Disease Drugs

Step 1

  • Cerezyme(imiglucerase)

Step 2

  • Elelyso (taliglucerase alfa)
  • VPRIV (velaglucerase alfa)

Gonadotropin Releasing Hormone Agonists

Step 1

  • Eligard (leuprolide acetate), doesn't require prior authorization

Step 2

  • Firmagon (degarelix)
  • Lupron Depot (leuprolide acetate for depot suspension)
  • Trelstar (triptorelin)
  • Zoladex (goserelin acetate)

Hyaluronates (Viscosupplements)

Step 1

  • Orthovisc (high molecular weight hyaluronan)
  • Synvisc (hylan G-F 20)
  • Synvisc One (hylan G-F 20)

Step 2

  • Durolane (hyaluronic acid)
  • Euflexxa (1% sodium hyaluronate)
  • Gel-One (cross-linked hyaluronate)
  • Gelsyn-3 (sodium hyaluronate)
  • GenVisc 850 (sodium hyaluronate)
  • Hyalgan (sodium hyaluronate)
  • Hymovis (high molecular weight viscoelastic hyaluronan)
  • Monovisc (high molecular weight hyaluronan)
  • Supartz FX (sodium hyaluronate)
  • Trivisc (sodium hyaluronate)
  • Visco-3 (sodium hyaluronate)

Multiple Sclerosis Drugs

Step 1

  • Tysabri (natalizumab)

Step 2

  • Lemtrada (alemtuzumab)

Ocular Disorder Drugs

Step 1

  • Avastin (bevacizumab), doesn't require prior authorization
  • Eylea (aflibercept)

Step 2

  • Lucentis (ranibizumab)
  • Macugen (pegaptanib sodium)
  • Visudyne (verteporfin)

Rituximab

Step 1

  • Rituxan Hycela (rituximab and hyaluronidase human)
  • Ruxience (rituximab-pvvr)
  • Truxima (rituximab-abbs)

Step 2

  • Rituxan (rituximab)

Trastuzumab

Step 1

  • Herceptin Hylecta (trastuzumab and hyaluronidase-oysk)
  • Herzuma (trastuzumab-pkrb)
  • Kanjinti (trastuzumab-anns)
  • Ogivri (trastuzumab-dkst)
  • Trazimera (trastuzumab-qyyp)

Step 2

  • Herceptin (trastuzumab)