Requirements for Part B drugs

Under Medicare Advantage plans, some medically administered Part B drugs, like injectables or biologics, may have special requirements or coverage limits. We’ll help you find the information you need.

How step therapy works

One of these special requirements or coverage limits is known as step therapy, where we require a trial of a preferred drug to treat a medical condition before covering another non-preferred drug.

Here’s an example:

If Drug A and Drug B both treat a medical condition, we may prefer Drug A and require a trial of it first. If Drug A does not work, we’ll then cover Drug B. The listed preferred products should be used first.

Note: The step therapy requirement does not apply to patients who’ve already received treatment with the non-preferred drug within the past 365 days.