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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: