Medicare Part B Prescription Drugs

Medicare Part B Step Therapy:

In some cases, we require you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may not cover Drug B unless you try Drug A first. If Drug A does not work for you, we will then cover Drug B. The list of preferred products should be used first.

Please note, this program applies to members who are new to therapy.

View our preferred drug list (PDF).

Medicare Part B Prior Authorization

Certain medical drugs require prior authorization to ensure safe and effective use. The prior authorization criteria are consistent with Medicare requirements defined in CMS National Coverage Determinations (NCDs) and relevant Local Coverage Determinations (LCDs).

Medicare Part B Prior Authorization Criteria

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