Medicare Part B Step Therapy: Changes for 2023

Effective Jan. 1, 2023, we are making the following changes to the Intravitreal Vascular Endothelial Growth Factor (VEGF) Inhibitors class and adding new drugs to the Medicare Part B Step Therapy program. 

VEGF class updates

Changes to the VEGF Inhibitors class include:

• All Intravitreal VEGF Inhibitors except compounded Avastin® will require prior authorization for all conditions, not just for neovascular (wet) age-related macular degeneration (AMD)
• Eylea® is now preferred: 
  • After compounded Avastin for AMD
  • For all other retinal conditions (non-AMD diagnoses)

Additions to the Step Therapy program

We are also adding several drugs to the Part B Step Therapy program effective Jan. 1, including:

• Bone-modifying agents for oncology and non-oncology use
• Gonadotropin releasing hormone analogs for oncology use
• Gout agents
• Immune globulins
• Intravenous iron products
• Systemic lupus erythematosus agents

Changes to impacted plans

As of Jan. 1, 2023, UnitedHealthcare® Medicare Advantage plans in California are no longer excluded from the Step Therapy program.

Questions?

For questions related to the step therapy program and the corresponding policy, call the Provider Services number on the member’s health care ID card.

PCA-1-22-03823-M&R-News_11142022