Part B Drug Step Therapy

What’s step therapy and how does it work?

Just because something’s expensive doesn’t mean it’s the best. If you’re a smart shopper, you find an option that costs less and works just as well.

That’s the idea behind step therapy. We use it to make sure you’re getting the most effective and reasonably-priced drug available.

Your pharmacists or doctor may tell you that some medications may need step therapy. They will review your medical information to find the best and lowest cost medication that can treat your problem.

Step therapy is trying lower-priced medications before taking a step up to one that costs more. Before trying an expensive drug, we’ll check to see if you’ve tried lower-priced drug options.

If you don’t follow the procedure for step therapy when it’s required, the drug may cost you more, or may not be covered at all.

Part B Step Therapy Drugs

These are the drugs the are Part B, meaning they are paid under your medical benefits

Drug ClassesDrug NameStatusBilling Code
Ophtalmic DisordersAvastinPreferredC9257, J9035
EyleaNon-PreferredJ0178
LucentisNon-PreferredJ2778
MacugenNon-PreferredJ2503
VisudyneNon-PreferredJ3396
ViscosupplementsMonoviscPreferredJ7327
OrthoviscNon-PreferredJ7324
DurolaneNon-PreferredJ7318
EuflexxaNon-PreferredJ7323
Gel-OneNon-PreferredJ7326
Gelsyn-3Non-PreferredJ7328
Genvisc 850Non-PreferredJ7320
HylaganNon-PreferredJ7321
HymovisNon-PreferredJ7322
SupartzNon-PreferredJ7321
Supartz FXNon-PreferredJ7321
SynviscNon-PreferredJ7325
Synvisc-OneNon-PreferredJ7325
TriViscNon-PreferredJ7329
Visco-3Non-PreferredJ7321

For providers: A trial and failure of the preferred drug must be documented before a non-preferred drug will be approved. All non-preferred drugs must be prior authorized. The preferred drugs do not require prior authorization.