Medicare Step and Clinical Policies

Medicare Part B Step Therapy and Clinical Policies

This list promotes the use of clinically appropriate, lower‑cost preferred drugs within select therapeutic classes. It applies only to the products listed; other medications may still be covered under the plan’s medical benefit.

Members must try preferred products first. An exception process is available when a non‑preferred drug is clinically necessary. Step therapy does not apply to members currently treated with a non‑preferred medication (i.e., those with a paid claim for it within the past 365 days).

Step Policies

Acromegaly-Long Acting

Alpha-1 Antitrypsin Deficiency

Autoimmune Infused - Infliximab

Autoimmune Infused - Other

Avastin and Biosimilars (Oncology)

Botulinum Toxins

Hematologic, Erythropoiesis Stimulating

Hematologic, Neutropenia Colony Long

Hematologic, Neutropenia Colony Short

Hematopoietic Agents - Iron

Immune Globulin