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Part B drugs and supplies

Part B of Original Medicare covers Medicare Part B drugs. Mercy Care Advantage members can get coverage for these drugs when medically necessary.

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

How to submit PA

Fax our Medical Prior Authorization Department at 1-800-217-9345. We’ll review:

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.

Read about Part B drugs in Chapter 4, Benefits Chart in the Mercy Care Advantage Evidence of Coverage English (PDF) | Español (PDF).

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