Part B Drug Step Therapy

Medicare Part B drugs are covered under Part B of Original Medicare.  Members of our plan can access coverage for these drugs when medically necessary.  For additional information, please see Chapter 4, Benefits Chart in the 2021 Mercy Care Advantage Evidence of Coverage.

CMS allows Medicare Advantage plans to implement Step Therapy requirements for the Part B drugs.  Starting January 1, 2021, Mercy Care Advantage members will be required to utilize the preferred Part B drugs listed on the CVS Caremark® Medical Preferred Drug List.

View the Part B Step Therapy drug list.

Providers may request prior authorization for a Medicare Part B drug when medically necessary.  Providers may also request a Step Therapy Exception, when they feel you need to use a non-preferred Part B drug.  If your condition requires the use of a Medicare Part B drug, your provider can submit a request for coverage to Mercy Care Advantage for review.  View the request form.

 

H5580_20_010
Last Updated: 1/12/2021