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Navigated to 2026 Step Therapy List for Medicare Part B Drugs page

2026 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) - J9305
  • Pemetrexed - J9294, J9296, J9297, J9314, J9322, J9323

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)
  • Avzivi (bevacizumab-tnjn)
  • Vegzelma (bevacizumab-adcd)

Breast Cancer Monoclonal Antibodies

Step 1

  • Phesgo (pertuzumab, trastuzumab, and hyaluronidase-zzxf)

Step 2

  • Perjeta (pertuzumab)

Cholesterol Lowering Drugs

Step 1

  • Repatha (evolocumab)

Step 2

  • Leqvio (inclisiran)

Colony Stimulating Factors – Long Acting

Step 1

  • Neulasta (pegfilgrastim)
  • Fulphila (pegfilgrastim-jmdb)

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

  • Bkemv (eculizumab-aeeb)
  • Vyvgart (efgartigimod alfa)
  • Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-qvfc)

Step 2

  • Soliris (eculizumab)
  • Ultomiris (Ravulizumab-cwvz)

Disease-Modifying Antirheumatic Drugs

Step 1

  • Entyvio (vedolizumab)
  • Simponi Aria (golimumab, intravenous)
  • Tremfya (guselkumab, 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
  • Nuwiq

Step 2

  • Advate
  • Kogenate
  • Novoeight
  • 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
  • Gammagard Liq.
  • Gammaked
  • Gamunex-C
  • Hizentra
  • Octagam
  • Privigen

Step 2

  • Asceniv
  • Alyglo
  • Bivigam
  • Cutaquig
  • Cuvitru
  • Gammaplex
  • HyQvia
  • Panzyga
  • Xembify
  • Yimmugo

Intravenous Iron Products

Step 1

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

Step 2

  • Injectafer (ferric carboxymaltose)
  • Monoferric (ferric derisomaltose)

Multiple Sclerosis Drugs

Step 1

  • Ocrevus (ocrelizumab)
  • Tysabri (natalizumab)

Step 2

  • Briumvi (ublituximab-xiiy)
  • Lemtrada (alemtuzumab)
  • Ocrevuz Zunovo (ocrelizumab and hyaluronidase-ocsq)
  • Tyruko (natalizumab-sztn)

Mitotic Inhibitors

Step 1

  • Docetaxel
  • Paclitaxel

Step 2

  • Abraxane (nabpaclitaxel)

Ocular Disorder Drugs

Step 1

  • Avastin (bevacizumab)

Step 2

  • Eylea (aflibercept)
  • Eylea High Dose (aflibercept)

Step 3

  • Beovu (brolucizumab-dbll)
  • Byooviz (ranibizumab-nuna)
  • Cimerli (ranibizumab-eqrn)
  • Lucentis (ranibizumab)
  • Opuviz (aflibercept-yszy)
  • Pavblu (aflibercept-ayyh)
  • Susvimo (ranibizumab)
  • Vabysmo (faricimab-svoa)

Osteoporosis Drugs - Bone Density

Step 1

  • Jubbonti (denosumab-bbdz)
  • Prolia (denosumab)
  • Reclast (Zoledronic Acid)

Step 2

  • Evenity (romosozumab-aqqg)

Programmed Cell Death (PD-1)/Programmed Cell Death Ligand (PD-L1) Drugs

Step 1

  • Libtayo (cemiplimab-rwlc)

Step 2

  • Imfinzi (durvalumab)
  • Keytruda (pembrolizumab)
  • Keytruda Qlex (pembrolizumab and berahyaluronidase alfa-pmph)
  • Opdivo (nivolumab)
  • Opdivo Qvantig (nivolumab and hyaluronidase-nvhy)
  • Tecentriq (atezolizumab)
  • Tecentriq Hybreza (atezolizumab and hyaluronidase-tqjs)

Rituximab Products

Step 1

  • Ruxience (rituximab-pvvr)
  • Truxima (rituximab-abbs)

Step 2

  • Riabni (rituximab-arrx)
  • Rituxan (rituximab)
  • Rituxan Hycela (rituximab and hyaluronidase human)

Severe Asthma

Step 1

  • Fasenra (benralizumab)
  • Tezspire (tezepelumab-ekko)
  • Xolair (omalizumab)

Step 2

  • Cinqair (reslizumab)
  • Nucala (mepolizumab)

Trastuzumab

Step 1

  • Kanjinti (trastuzumab-anns)
  • Ogivri (trastuzumab-dkst)
  • Ontruzant (trastuzumab-dttb)

Step 2

  • Herceptin (trastuzumab)
  • Herceptin Hylecta (trastuzumab and hyaluronidase-oysk)
  • Hercessi (trastuzumab-strf)
  • Herzuma (trastuzumab-pkrb)
  • Trazimera (trastuzumab-qyyp)