Step Therapy

Some Medicare Part B drugs in your D-SNP Drug List follow rules and coverage limits. Known as step therapy, these rules are limits apply to medically administered drugs like injectables or biologics.

How Step Therapy Works

If your doctor prescribes injectable or biologic drugs to treat a condition, your D-SNP prescription benefit step therapy will first have you try using a preferred drug before covering a non-preferred drug. Taking these steps helps you keep your costs down and helps you avoid treatment limits.

Before starting a new medication, you can check your Medicare Part B Drug List to see if you’ll need to follow step therapy rules.

View 2024 Medicare Part B Step Therapy Drug List 

Step Therapy Example

Here’s an example to help explain how step therapy might work.

Imagine Drug A (preferred) and Drug B (non-preferred) are both used to treat the same medical condition. Your D-SNP may require that you try Drug A (preferred) first. If Drug A does not work, Drug B (non-preferred) will be covered.

Important Step Therapy Details

Here are some important things to keep in mind:

• The step therapy requirement does not apply to you if you’ve already received treatment with the non-preferred drug within the past 365 days.
• Both preferred and non-preferred drugs may still be subject to prior authorization or quantity limits.

VIEW PRESCRIPTION DRUG BENEFITS

Get Your Questions Answered

If you have questions about step therapy, or your prescription drug benefits, please call Member Services at 1-844-339-7684 (TTY 711).