In August 2018, the Centers for Medicare & Medicaid Services (CMS) rescinded its September 2012 memo “Prohibition on Imposing Mandatory Step Therapy for Access to Part B Drugs and Services.” CMS now allows Medicare Advantage plans to apply step therapy for physician-administered and other Part B drugs.

Step therapy is a type of pre-authorization for drugs that require patients to initiate treatment for a medical condition with the most preferred drug therapy. Patients then progress to other therapies only if necessary.

Due to the 2018 change, CarePlus will require a review of some injectable drugs and biologics for step therapy requirements in addition to current review requirements. The affected drugs/devices are indicated on the PDFPart B Step Therapy Preferred Drug List (PDF opens in new window).

CarePlus works to ensure continuous provision of necessary drugs to members during a transition period.

PDFPart D Prescription Drug Plan Transition Policy for Providers (PDF opens in new window)