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Part B drug step therapy
The Centers for Medicare & Medicaid Services (CMS) allows us to use step therapy requirements for Part B drugs. We have done so and use the 2023 CVS Caremark® Advanced Biosimilars - First Medical Preferred Drug List - Medicare Part B Step Therapy (PDF), or the 2024 CVS Caremark® Advanced Biosimilars - First Medical Preferred Drug List - Medicare Part B Step Therapy (PDF).
Prior authorization (PA)
Your provider can ask for:
- PA for Medicare Part B drugs
- An exception for non-preferred Medicare Part B drugs instead of preferred Part B drugs: usually applies when you’re already in an active course of treatment
Just ask your provider to send a supporting statement with their request. We’ll review:
- Standard requests within 72 hours
- Expedited requests within 24 hours
Glucose meters and supplies
- FreeStyle Libre® and Dexcom® are the preferred brands of continuous glucose meters and supplies.
- OneTouch® is the preferred brand of glucose meters and test strips.
- Non-preferred diabetes supplies need PA.
Learn more about Part B
Read about Part B drugs in Chapter 4, Benefits Chart in the Mercy Care Advantage 2023 Evidence of Coverage (PDF) or the 2024 Evidence of Coverage (PDF).
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