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)