2027 Step Therapy List for 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. If needed, you can also review our internal coverage criteria for part B drugs.

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

Step 2

• Lanreotide Acetate
• Sandostatin LAR Depot (octreotide acetate for injectable suspension)
• Signifor LAR

Alpha1-Proteinase Inhibitors

Step 1

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

Step 2

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

Antimetabolites

Step 1

• Alimta (pemetrexed) - J9305
• Pemetrexed - J9294, J9296, J9297, J9314, J9322, J9323

Step 2

• Axtle (pemetrexed) - J9292
• Pemfexy (pemetrexed) - J9304
• Pemrydi (pemetrexed) - J9324

Bendamustine Products

Step 1

• Bendamustine - J9033, J9058, J9059

Step 2

• Bendeka
• Belrapzo
• Vivimusta

Bevacizumab for Cancer Related Use

Step 1

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

Step 2

• Avastin (bevacizumab)
• Avzivi (bevacizumab-tnjn)
• Jobevne (bevacizumab-nwgd)
• Vegzelma (bevacizumab-adcd)

Breast Cancer Monoclonal Antibodies

Step 1

• Phesgo (pertuzumab, trastuzumab, and hyaluronidase-zzxf)

Step 2

• Perjeta (pertuzumab)

Cholesterol Lowering Drugs

Step 1

• Repatha (evolocumab) - Part D Only

Step 2

• Leqvio (inclisiran)

Colony Stimulating Factors – Long Acting

Step 1

• Neulasta (pegfilgrastim)
• Fulphila (pegfilgrastim-jmdb)
• Udenyca (pegfilgrastim-cbqv)

Step 2

• Armlupeg (pegfilgrastim-unne)
• Fylnetra (pegfilgrastim-pbbk)
• Nyvepria (pegfilgrastim-apgf)
• Rolvedon (eflapegrastim-xnst)
• Ryzneuta (efbemalenograstim alfa-vuxw)
• Stimufend (pegfilgrastim-fpgk)
• Ziextenzo (pegfilgrastim-bmez)

Colony Stimulating Factors – Short Acting

Step 1

• Zarxio (filgrastim-sndz)

Step 2

• Granix (TBO-filgrastim)
• Leukine (sargramostim)
• Neupogen (filgrastim)
• Nivestym (filgrastim-aafi)
• Nypozi (filgrastim-txid)
• Releuko (filgrastim-ayow)

Complement Inhibitors - Atypical Hemolytic Uremic Syndrome and Misc.

Step 1

• Epysqli (eculizumab-aagh)
• Ultomiris (Ravulizumab-cwvz)

Step 2

• Bkemv (eculizumab-aeeb)
• Soliris (eculizumab)

Complement Inhibitors - Neuromyelitis Optica Spectrum Disorder

Step 1

• Bkemv (eculizumab-aeeb)
• Uplizna (inebilizumab-cdon)

Step 2

• Epysqli (eculizumab-aagh)
• Soliris (eculizumab)
• Ultomiris (Ravulizumab-cwvz)

Disease-Modifying Antirheumatic Drugs

Step 1

• Entyvio (vedolizumab)
• Ilumya (tildrakizumab-asmn)
• Simponi Aria (golimumab, intravenous)

Step 2

• Cimzia (certolizumab pegol)
• Imuldosa (ustekinumab-srlf)
• Omvoh (mirikizumab-mrkz)
• Orencia (abatacept)
• Otulfi (ustekinumab-aauz)
• Pyzchiva (ustekinumab-ttwe)
• Selarsdi (ustekinumab-aekn)
• Skyrizi (risankizumab-rzaa)
• Starjemza (ustekinumab-hmny)
• Stelara IV (ustekinumab)
• Tremfya (guselkumab, intravenous)
• Wezlana (ustekinumab-auub)
• Yesintek (ustekinumab-kfce)

Erythropoiesis Stimulating Drugs

Step 1

• Aranesp (darbepoetin alfa)
• Procrit (epoetin alfa)

Step 2

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

Gaucher Disease Drugs

Step 1

• Elelyso (taliglucerase alfa)
• Cerezyme (imiglucerase)

Step 2

• VPRIV (velaglucerase alfa)

Gemcitabine Products

Step 1

• Gemcitabine - J9201

Step 2

• Avgemsi (gemcitabine)
• Gemcitabine (Accord) - J9196

Hemophilia Factor VIII Products - Long-Acting

Step 1

• Adynovate
• Altuviiio
• Eloctate

Step 2

• Esperoct
• Jivi

Hemophilia Factor VIII Products - Recombinant

Step 1

• Afstyla
• Kovaltry
• Nuwiq

Step 2

• Advate
• Kogenate
• Novoeight
• Recombinate
• Xyntha
• Xyntha Solofuse

Hemophilia Factor VIII Products - Recombinant

Step 1

• Alprolix
• Idelvion
• Rebinyn

Step 2

• Benefix
• Ixinity
• Rixubis

Hereditary Transthyretin Amyloidosis - Cardiomyopathy

Step 1

• Vyndamax (Part D Only)

Step 2

• Amvuttra

Hyaluronates (Viscosupplements)

Step 1

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

Step 2

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

Hypercalcemia of Malignancy

Step 1

• Bilprevda (denosumab-nxxp)
• Pamidronate
• Wyost (denosumab-bbdz)
• Xgeva (denosumab)
• Zometa (zoledronic acid)

Step 2

• Aukelso (denosumab-kyqq)
• Bomyntra (denosumab-bnht)
• Jubereq (denosumab-desu)
• Osenvelt (denosumab-bmwo)
• Oziltus (denosumab-mobz)
• Xbryk (denosumab-dssb)
• Xtrenbo (denosumab-qbde)

Infliximab Products

Step 1

• Inflectra (infliximab-dyyb)
• Renflexis (infliximab-abda)

Step 2

• Avsola (infliximab-axxq)
• Infliximab
• Remicade (infliximab)

Immune Globulin Products

Step 1

• Cutaquig
• Flebogamma
• Gammagard Liq.
• Gammaked
• Gamunex-C
• Hizentra
• Octagam
• Privigen

Step 2

• Asceniv
• Alyglo
• Bivigam
• Cuvitru
• Gammaplex
• HyQvia
• Panzyga
• Qivigy
• Xembify
• Yimmugo

Intravenous Iron Products

Step 1

• Feraheme (ferumoxytol)
• Ferrlecit (ferric gluconate)
• Infed (iron dextran)
• Sodium Ferric Gluconate
• Venofer (iron sucrose)

Step 2

• Injectafer (ferric carboxymaltose)
• Monoferric (ferric derisomaltose)

Liposarcoma Drugs

Step 1

• Halaven

Step 2

• Evdi
• Yondelis

Multiple Myeloma Biologic Drugs

Step 1

• Velcade (bortezomib) - J9041, J9046, J9048, J9049, J9051

Step 2

• Boruzu (bortezomib) - J9054

Multiple Myeloma - Proteasome Inhibitors

Step 1

• Tecvayli

Step 2

• Elrexfio
• Talvey

Multiple Sclerosis Drugs

Step 1

• Briumvi (ublituximab-xiiy)
• Ocrevus (ocrelizumab)
• Tysabri (natalizumab)

Step 2

• Lemtrada (alemtuzumab)
• Ocrevus Zunovo (ocrelizumab and hyaluronidase-ocsq)
• Tyruko (natalizumab-sztn)

Mitotic Inhibitors

Step 1

• Docetaxel
• Paclitaxel

Step 2

• Abraxane (nabpaclitaxel)
• Beizray (docetaxel)
• Docivyx (docetaxel)

Myasthenia Gravis Drugs

Step 1

• Vyvgart
• Vyvgart Hytrulo

Step 2

• Bkemv
• Epysqli
• Imaavy
• Rystiggo
• Soliris
• Ultomiris
• Upliza

Myelodysplastic Syndrome Drugs

Step 1

• Reblozyl

Step 2

• Rytelo

Non-Muscle Invasive Bladder Cancer

Step 1

• Adstiladrin
• Keytruda

Step 2

• Anktiva
• Inlexzo

Ocular Disorder Drugs

Step 1

• Eylea (aflibercept)
• Eylea High Dose (aflibercept)
• Lucentis (ranibizumab)
• Pavblu (aflibercept-ayyh)

Step 2

• Ahzantive (aflibercept-mrbb)
• Beovu (brolucizumab-dbll)
• Byooviz (ranibizumab-nuna)
• Cimerli (ranibizumab-eqrn)
• Enzeevu (aflibercept-abzv)
• Eydenzelt (aflibercept-boav)
• Lytenava (bevacizumab-vikg)
• Nufymco (ranibizumab-leyk)
• Opuviz (aflibercept-yszy)
• Susvimo (ranibizumab)
• Vabysmo (faricimab-svoa)
• Yesafili (aflibercept-jbvf)

Ophthalmic Geographic Atrophy

Step 1

• Izervay

Step 2

• Syfovre

Osteoporosis Drugs - Bone Density

Step 1

• Bildyos (denosumab-nxxp)
• Jubbonti (denosumab-bbdz)
• Prolia (denosumab)
• Reclast (Zoledronic Acid)

Step 2

• Boncresa (denosumab-mobz)
• Bosaya (denosumab-kyqq)
• Conexxence (denosumab-bnht)
• Enoby (denosumab-qbde)
• Evenity (romosozumab-aqqg)
• Ospomyv (denosumab-dssb)
• Osvyrti (denosumab-desu)
• Ponlimsi (denosumab-adet)
• Stoboclo (denosumab-bmwo)

Programmed Cell Death (PD-1)/Programmed Cell Death Ligand (PD-L1) Drugs

Step 1

• Libtayo (cemiplimab-rwlc)

Step 2

• Imfinzi (durvalumab)
• Keytruda (pembrolizumab)
• Keytruda Qlex (pembrolizumab and berahyaluronidase alfa-pmph)
• Opdivo (nivolumab)
• Opdivo Qvantig (nivolumab and hyaluronidase-nvhy)
• Tecentriq (atezolizumab)
• Tecentriq Hybreza (atezolizumab and hyaluronidase-tqjs)
• Unloxcyt (cosibelimab-ipdl)

Prostate Cancer - Luteinizing Hormone-Releasing Hormone Drugs

Step 1

• Eligard
• Lupron

Step 2

• Camcevi
• Firmagon
• Trelstar
• Zoladex

Rituximab Products

Step 1

• Ruxience (rituximab-pvvr)
• Truxima (rituximab-abbs)

Step 2

• Riabni (rituximab-arrx)
• Rituxan (rituximab)
• Rituxan Hycela (rituximab and hyaluronidase human)

Severe Asthma

Step 1

• Fasenra (benralizumab)
• Tezspire (tezepelumab-ekko)
• Xolair (omalizumab)

Step 2

• Cinqair (reslizumab)
• Exdensur (depemokimab-ulaa)
• Nucala (mepolizumab)

Tocilizumab Products

Step 1

• Avtozma (tocilizumab-anoh)
• Tofidence (tocilizumab-bavi)
• Tyenne (tocilizumab-aazg)

Step 2

• Actemra (tocilizumab)

Trastuzumab Products

Step 1

• Kanjinti (trastuzumab-anns)
• Ogivri (trastuzumab-dkst)
• Ontruzant (trastuzumab-dttb)

Step 2

• Herceptin (trastuzumab)
• Herceptin Hylecta (trastuzumab and hyaluronidase-oysk)
• Hercessi (trastuzumab-strf)
• Herzuma (trastuzumab-pkrb)
• Trazimera (trastuzumab-qyyp)