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 Classes
Drug Name
Status
Billing Code
Ophtalmic Disorders
Avastin
Preferred
C9257, J9035
Eylea
Non-Preferred
J0178
Lucentis
Non-Preferred
J2778
Macugen
Non-Preferred
J2503
Visudyne
Non-Preferred
J3396
Viscosupplements
Monovisc
Preferred
J7327
Orthovisc
Non-Preferred
J7324
Durolane
Non-Preferred
J7318
Euflexxa
Non-Preferred
J7323
Gel-One
Non-Preferred
J7326
Gelsyn-3
Non-Preferred
J7328
Genvisc 850
Non-Preferred
J7320
Hylagan
Non-Preferred
J7321
Hymovis
Non-Preferred
J7322
Supartz
Non-Preferred
J7321
Supartz FX
Non-Preferred
J7321
Synvisc
Non-Preferred
J7325
Synvisc-One
Non-Preferred
J7325
TriVisc
Non-Preferred
J7329
Visco-3
Non-Preferred
J7321
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.
