April 4, 2019
CMS issued new guidance regarding step therapy for certain Medicare Part B specialty drugs. The new guidance took effect January 1, 2019 and applies to all Premera Blue Cross Medicare Advantage (MA) plans.
Step therapy is treatment for a medical condition that starts with the most preferred drug therapy and progresses to other drug therapies only if necessary.
What’s changing?
Drugs requiring step therapy are listed on the prior authorization list. For drugs requiring step therapy, authorization request questions will be different from the ones you currently answer. Here are some examples of drugs that require step therapy:
- Botox® for migraines and over active bladder
- Eylea®, Lucentis® and Macugen® for neovascular age-related macular edema
- Prolia® for osteoporosis
You can submit your prior authorization requests for all Part B specialty drugs online by visiting our MA website and logging in to access online tools. You’ll also find the prior authorization list with all Part B drugs that require prior authorization.