Part B Drug Step Therapy

Medicare Part B drugs are covered under Part B of Original Medicare. MCA members can access coverage for these drugs when medically necessary. For additional coverage information about Part B drugs, please reference the Mercy Care Advantage Evidence of Coverage, Chapter 4, Benefits Chart.  

CMS allows Medicare Advantage plans to implement Step Therapy requirements for the Part B drugs. Mercy Care Advantage has implemented Step Therapy for Part B drugs and utilizes the CVS Caremark® Medical Preferred Part B Step Therapy drug list.

View the 2022 Part B Step Therapy drug list.

Providers may request prior authorization for Medicare Part B drugs when medically necessary. Providers may also request prior authorization for a member to use a non-preferred Part B drug instead of the Preferred Part B Step Therapy drug. For this situation the provider will need to include a supporting statement. This situation typically applies when a member is already in an active course of treatment. Prior authorization requests for Part B drugs will be reviewed and processed within 24 hours for an expedited request and 72 hours for a standard request.

 

H5580_20_010
Last Updated: 6/22/2022