Part B Step Therapy
We give you the information you need to take care of your health.
In some cases, we require you to first try one drug to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may require your doctor to prescribe Drug A first. If Drug A does not work for you, then we will cover Drug B. This Step Therapy Program encourages Medicare Advantage members to try less costly, but just as effective, Part B drugs before the plan covers another drug. We give you the information you need to take care of your health.
The list of Part B drugs and Preferred Alternatives below are impacted by Braven Health’s Step Therapy program:
| Requested Product | Preferred Alternative Agent(s) | Included in the program beginning |
|---|---|---|
| Abraxane® | Paclitaxel (off-label uses only) | January 1, 2021 |
| Aloxi | Zofran, Kytril | January 1, 2021 |
| Avastin® | Mvasi™, Zirabev® | January 1, 2021 |
| Elelyso | Cerezyme, Cerdelga | January 1, 2021 |
| Epogen/Procrit | Biosimilar epoetin alfa (Retacrit) | January 1, 2021 |
| Fusilev | Leucovorin | January 1, 2021 |
| Fusilev®, Khapzory™ | leucovorin | January 1, 2021 |
| Herceptin® | Kanjinti™, Ogivri™, Trazimera™ | January 1, 2021 |
| Herzuma® | Kanjinti™, Ogivri™, Trazimera™ | January 1, 2021 |
| Infugem™ | gemcitabine | January 1, 2021 |
| Lemtrada | Avonex, Rebif, Betaseron, Extavia, Tysabri, Copaxone, Tysabri, Ocrevus, Tecfidera, Gilenya, Aubagio | January 1, 2021 |
| Marqibo® | vincristine sulfate | October 15, 2021 |
| Neupogen | Granix, Zarxio | January 1, 2021 |
| Ontruzant® | Kanjinti™, Ogivri™, Trazimera™ | January 1, 2021 |
| Prolia | Reclast | January 1, 2021 |
| Rituxan® | Truxima®, Ruxience® | January 1, 2021 |
| Soliris® | Ultomiris® | January 1, 2021 |
| Sustol | Aloxi, Zofran, Kytril | January 1, 2021 |
| Treanda® | Bendeka®, Belrapzo™ | January 1, 2021 |
| Tysabri | For Multiple Sclerosis: Interferon beta (i.e. Avonoex, Rebif, Betaseron, Extavia), Copaxone
For Crohn’s Disease: Immunosuppressants (5-ASA, 6-mercaptopurine, azathioprine, cyclosporine, methotrexate), TNF Antagonist |
January 1, 2021 |
| Vpriv | Cerezyme, Cerdelga | January 1, 2021 |
| Xgeva | Zometa | January 1, 2021 |
| Ziextenzo® | Neulasta®, Fulphila®, Udencya® | January 1, 2021 |