Another group or vendor provides the info on the next page. If you don’t want to leave our site, choose the “X” in the upper right corner to close this message. Or choose “Go on” to move forward.
Part B drug step therapy
The Centers for Medicare & Medicaid Services (CMS) lets Medicare Advantage plans implement step therapy requirements for Part B drugs. We have done so and use the CVS Caremark® Advanced Biosimilars - First Medical Preferred Drug List - Medicare Part B Step Therapy (PDF).
You can submit PA for:
Medicare Part B drugs that are medically necessary
Non-preferred Medicare Part B drugs instead of preferred Part B drugs: usually applies when people are already in an active course of treatment
Just provide one of these:
A supporting statement reflecting trial and failure of the preferred drug
A medical reason the member can’t take the preferred drug
A medical reason the preferred drug wouldn’t be as effective as the requested non-preferred drug
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.
All trademarks are the property of their respective owners.