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:

• PDFPart B Step Therapy Preferred Drug List — English (PDF opens in new window) 
• PDFPart B Step Therapy Preferred Drug List — Spanish (PDF opens in new window)