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 2026 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
How to submit PA
Fax our Medical Prior Authorization Department at 1-800-217-9345. We’ll review:
Standard requests within 72 hours
Expedited requests within 24 hours
Glucose meters and supplies
We cover blood glucose meters and test strips from TRUE/Trividia meters. We also cover Dexcom and FreeStyle Libre continuous glucose monitors and sensors. Other brands will not be covered unless you get approval from us first.
Learn more about Part B
Read about Part B drugs in Chapter 4, Benefits Chart in the Mercy Care Advantage Evidence of Coverage 2026 EOC - ACC DD or 2026 EOC - ALTCS.
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Questions?
Call 602-414-7630 or 1-866-571-5781 (TTY 711)
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