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Step Therapy for Part B Drugs

Some Part B drugs may require step therapy. 

Drugs that are injected or infused by your physician in their office, or in a hospital outpatient or ambulatory surgical center are typically covered under your medical (Part B) benefit.  Some Part B drugs may require step therapy.  Step therapy means that a preferred drug must be tried before a non-preferred drug will be approved by your plan.  If you have already been on a non-preferred drug in the previous 365 days, you may continue using the non-preferred drug. 
Drugs listed in the “Non-Preferred Drug Products” column below may be subject to Step Therapy when administered for the first time:
In Scope Drug Category Non-Preferred Drug Products Preferred Drug Products
Inflammatory Conditions (such as Rheumatoid Arthritis) Remicade
Renflexis
Inflectra
Avsola
Red Blood Cell Generation Epogen
Procrit
Retacrit
White Blood Cell Generation (Short Acting) Neupogen
Granix
Nivestym
Zarxio*
White Blood Cell Generation (Long Acting) Fulphilia
Udenyca
Nyvepria
Neulasta*
Ziextenzo*
Orthopedic Joint Lubricant (Medical Device) Euflexxa,
Gel-One,
Genvisc 850,
Hyalgan,
Hymovis,
Monovisc,
Orthovisc,
Supartz,
Supartz FX,
Synojoynt,
Triluron,
TriVisc,
Visco-3
Durolane
Gelsyn-3
Synvisc/Synvisc-One
Nebulizer Solutions (dispensed at a pharmacy) Brovana Perforomist
Vascular Endothelial Growth Factor (VEGF) Inhibitors (for eye conditions) Beovu
Eylea
Lucentis
Compounded Avastin
(bevacizumab)
Rituximab Products (for both cancer and non-cancer conditions) Riabni
Rituxan
Rituxan Hycela
Ruxience*
Truxima*
Bevacizumab Products (for cancer conditions only) Avastin Mvasi*
Zirabev*
Trastuzumab Products Herceptin
Herceptin Hylecta
Herzuma
Ogivri
Ontruzant
Kanjinti*
Trazimera*
Leucovorin/Levoleucovorin Fusilev
Khapzory
Levoleucovorin
Leucovorin*
Gemcitabine Infugem (J9198) Gemcitabine (J9201)*
Anti-Nausea Products for Oncology (specifically when used as part of a chemotherapy regimen) Akynzeo
Aloxi
Cinvanti
Sustol
Emend*
Granisetron (Kytril)
Ondansetron (Zofran)
*No prior authorization is required for Preferred Drug Products except when used for cancer diagnoses.

Only certain plans will require step therapy for these Part B drugs.  If you are using one of these drugs under the Part B benefit, please contact the customer service center at the phone number on the back of your ID card to determine if your plan is in scope.

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