Medicare Advantage Part B step therapy enhancements effective April 1, 2024

April 1, 2024

Step therapy is a required process that applies to certain Medicare Advantage Part B prescription drugs. It requires customers to first try a preferred medication over a non-preferred medication that treats the same condition. If the preferred medication is proven to be ineffective or causes negative side effects, a non-preferred medication may then be covered.

Part B step therapy updates effective on April 1, 2024

As part of our continuing efforts to reduce drug costs while maintaining access for customers,  enhancements to the Medicare Advantage Part B step therapy program became effective April 1, 2024.

Step therapyAffected drugsPreferred or nonpreferred?Part B precertification required?Part B step therapy required?
Botulinum toxinBOTOX® Dysport® Xeomin® DAXXIFY®PreferredYesNo
Testosterone injectablesDepo®-Testosterone DELATESTRYL®PreferredNoNo
SomatostatinSomatuline® DepotPreferredYesNo
Sandostatin® LAR LanreotideNon-PreferredYesYes

Resources and forms
Drug/biologic step therapy requirements…………….. 2024 Part B Step Therapy Quick Reference Guide
Step therapy precertification forms…………………… > Part B Drugs/Biologics: Drugs/Biologics Part B Step Therapy Precertification Forms
Part B precertification and step therapy requests…. Fax: 877.730.3858
Precertification team (additional assistance)……….. Phone: 888.454.0013

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