2025 Step Therapy List for Medicare Part B Drugs

Here's a closer look at how step therapy works and which drugs require it. To learn more about step therapy and other rules for Part B and Part D drugs, check our drug coverage limits page. If needed, you can also review our internal coverage criteria for part B drugs.

How Step Therapy Works

In the list below, you'll see drugs labeled as either Step 1 or Step 2. Step 2 drugs are the ones that require step therapy. Before you can get them, you have to first try a Step 1 drug.

Step 1 drugs usually require prior authorization. That means before you can take this drug, your doctor has to send us information that explains why you need it. If a Step 1 drug doesn't require prior authorization, we tell you in the list below.

Step 2 drugs always require prior authorization. Your doctor also needs to let us know one of the following:

Why the Step 1 drug didn’t work for you or why you can’t take the Step 1 drug
Why the Step 1 drug is best for your needs
Details from your doctor to show that you've taken the Step 2 drug in the past 365 days

Acromegaly Drugs

Step 1

Somatuline Depot

Step 2

Lanreotide Acetate
Sandostatin LAR Depot (octreotide acetate for injectable suspension)
Signifor LAR

Alpha1-Proteinase Inhibitors

Step 1

Prolastin-C (alpha1-proteinase inhibitor [human])
Zemaira (alpha1-proteinase inhibitor [human])

Step 2

Aralast NP (alpha1-proteinase inhibitor [human])
Glassia (alpha1-proteinase inhibitor [human])

Antimetabolites

Step 1

Alimta (pemetrexed) - J9294, J9296, J9297, J9314, J9305, J9322

Step 2

Pemfexy (pemetrexed) - J9304
Pemrydi (pemetrexed) - J9324

Bevacizumab for Cancer Related Use

Step 1

Mvasi (bevacizumab-awwb)
Zirabev (bevacizumab-bvzr)

Step 2

Alymsys (bevacizumab-maly)
Avastin (bevacizumab)
Vegzelma (bevacizumab-adcd)

Breast Cancer Monoclonal Antibodies

Step 1

Phesgo (pertuzumab, trastuzumab, and hyaluronidase-zzxf)

Step 2

Perjeta (pertuzumab)

Colony Stimulating Factors – Long Acting

Step 1

Fulphila (pegfilgrastim-jmdb)
Neulasta (pegfilgrastim)

Step 2

Fylnetra (pegfilgrastim-pbbk)
Nyvepria (pegfilgrastim-apgf)
Rolvedon (eflapegrastim-xnst)
Stimufend (pegfilgrastim-fpgk)
Udenyca (pegfilgrastim-cbqv)
Ziextenzo (pegfilgrastim-bmez)

Colony Stimulating Factors – Short Acting

Step 1

Zarxio (filgrastim-sndz)

Step 2

Granix (TBO-filgrastim)
Leukine (sargramostim)
Neupogen (filgrastim)
Nivestym (filgrastim-aafi)
Releuko (filgrastim-ayow)

Complement Inhibitors

Step 1

Soliris (eculizumab)
Ultomiris (Ravulizumab-cwvz)

Step 2

Uplizna (inebilizumab-cdon)

Disease-Modifying Antirheumatic Drugs

Step 1

Entyvio (vedolizumab)
Simponi Aria (golimumab, intravenous)

Step 2

Actemra (tocilizumab)
Cimzia (certolizumab pegol)
Ilumya (tildrakizumab-asmn)
Orencia (abatacept)
Stelara IV (ustekinumab)

Erythropoiesis Stimulating Drugs

Step 1

Aranesp (darbepoetin alfa)
Procrit (epoetin alfa)

Step 2

Epogen (epoetin alfa)
Mircera (methoxy polyethylene glycol-epoetin beta)
Retacrit (epoetin alfa)

Gaucher Disease Drugs

Step 1

Elelyso (taliglucerase alfa)
Cerezyme (imiglucerase)

Step 2

VPRIV (velaglucerase alfa)

Hemophilia Factor VIII Products

Step 1

Adynovate
Afstyla
Altuviiio
Jivi
Kovaltry

Step 2

Advate
Kogenate
Novoeight
Nuwiq
Recombinate
Xyntha
Xyntha Solofuse

Hyaluronates (Viscosupplements)

Step 1

Durolane (hyaluronic acid)
Euflexxa (1% sodium hyaluronate)
Synvisc (hylan G-F 20)
Synvisc One (hylan G-F 20)

Step 2

Gel-One (cross-linked hyaluronate)
Gelsyn-3 (sodium hyaluronate)
GenVisc 850 (sodium hyaluronate)
Hyalgan (sodium hyaluronate)
Hymovis (high molecular weight viscoelastic hyaluronan)
Monovisc (high molecular weight hyaluronan)
Orthovisc (high molecular weight hyaluronan)
Supartz FX (sodium hyaluronate)
Triluron (sodium hyaluronate)
Trivisc (sodium hyaluronate)
Visco-3 (sodium hyaluronate)

Infliximab Products

Step 1

Inflectra (infliximab-dyyb)
Renflexis (infliximab-abda)

Step 2

Avsola (infliximab-axxq)
Infliximab
Remicade (infliximab)

Immune Globulin Products

Step 1

Flebogamma
Gammaked
Gamunex-C
Hizentra
Octagam
Privigen

Step 2

Asceniv
Bivigam
Cutaquig
Cuvitru
Gammagard Liq.
Gammaplex
HyQvia
Panzyga
Xembify

Intravenous Iron Products

Step 1

Ferrlecit (ferric gluconate)
Infed (iron dextran)
Sodium Ferric Gluconate
Venofer (iron sucrose)

Step 2

Feraheme (ferumoxytol)
Injectafer (ferric carboxymaltose)
Monoferric (ferric derisomaltose)

Multiple Sclerosis Drugs

Step 1

Tysabri (natalizumab)
Ocrevus (ocrelizumab)

Step 2

Lemtrada (alemtuzumab)
Briumvi (ublituximab-xiiy)

Mitotic Inhibitors

Step 1

Docetaxel
Paclitaxel

Step 2

Abraxane (nabpaclitaxel)

Ocular Disorder Drugs

Step 1

Avastin (bevacizumab)

Step 2

Byooviz (ranibizumab-nuna)
Eylea (aflibercept)
Eylea High Dose (aflibercept)

Step 3

Beovu (brolucizumab-dbll)
Cimerli (ranibizumab-eqrn)
Lucentis (ranibizumab)
Susvimo (ranibizumab)
Vabysmo (faricimab-svoa)

Osteoporosis Drugs - Bone Density

Step 1

Prolia (denosumab)
Zoledronic Acid

Step 2

Evenity (romosozumab-aqqg)

Osteoporosis Drugs - Bone Metastases From Cancer

Step 1

Pamidronate
Zoledronic Acid

Step 2

Xgeva (denosumab)

Rituximab Products

Step 1

Rituxan (rituximab)
Rituxan Hycela (rituximab and hyaluronidase human)
Ruxience (rituximab-pvvr)

Step 2

Riabni (rituximab-arrx)
Truxima (rituximab-abbs)

Severe Asthma

Step 1

Fasenra (benralizumab)
Xolair (omalizumab)

Step 2

Cinqair (reslizumab)
Nucala (mepolizumab)
Tezspire (tezepelumab-ekko)

Trastuzumab

Step 1

Kanjinti (trastuzumab-anns)
Ogivri (trastuzumab-dkst)
Trazimera (trastuzumab-qyyp)

Step 2

Herceptin (trastuzumab)
Herceptin Hylecta (trastuzumab and hyaluronidase-oysk)
Herzuma (trastuzumab-pkrb)
Ontruzant (trastuzumab-dttb)