Beginning January 1, 2022, the below list of drugs will require step therapy for Medicare members as part of medical drug review. There are also nine drugs that as of January 1, 2022 will require prior authorization (PA) for the first time but will also have step therapy.
- Will require documentation of trial and failure of Kanjinti and Trazimera (PA already exists):
J9355 Herceptin
- Will require documentation of trial and failure of Truxima and Riabni (PA already exists):
J9312 Rituxan
Q5119 Ruxience
J9310 Rituximab
- Will require documentation of trial and failure of Avastin, Mvasi, and Zirabev (PA already exists):
J0178 Eyelea
J0179 Beovu
J2778 Lucentis
- Will require documentation of trial and failure of Zoledronic acid (PA already exists):
J0897 Xgeva
J0897 Prolia
- Will require documentation of trial and failure of Euflexxa, Orthovisc, and Durolane (PA required as of January 1, 2022):
J7327 Monvisc
J7325 Synvisc
J7321 Hyalgan
J7328 Gelsyn
J7321 Supartz
J7320 Genvisc
J7329 Trvisc
J7322 Hymovis
J7332 Triluron
- Will require documentation of trial and failure of Remicade, Inflectra, and Avsola (PA already exists):
Q5104 Renflexis
- Will require documentation of trial and failure of Neulasta and Udenyca (PA already exists):
Q5122 Byvepria
Q5108 Fulphila
Q5120 Ziextenzo
- Will require documentation of trial and failure of Sandostatin LAR (PA already exists):
J1930 Somatuline Depot