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
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.
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.