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The Centers for Medicare & Medicaid Services (CMS) now allows Medicare Advantage (MA) plans to apply step therapy for physician-administered and other Part B drugs.
Step therapy is a type of prior 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.
CarePlus will review some injectable drugs and biologics for step therapy requirements, in addition to current prior authorization review requirements. You can find a list of the drugs and biologics we will review, as well as alternatives to non-preferred drugs subject to step-therapy, here: