Beginning 1 de janeiro, 2022, the below list of drugs will require step therapy for Medicare members as part of medical drug review. There are also nine drugs that as of 1 de janeiro, 2022 will require prior authorization (PA) for the first time but will also have step therapy.

• Will require documentation of trial and failure of Kanjinti and Trazimera (PA already exists):

J9355         Herceptin

• Will require documentation of trial and failure of Truxima and Riabni (PA already exists):

J9312         Rituxan

Q5119       Ruxience

J9310         Rituximab

• Will require documentation of trial and failure of Avastin, Mvasi, and Zirabev (PA already exists):

J0178         Eyelea

J0179         Beovu

J2778         Lucentis

• Will require documentation of trial and failure of Zoledronic acid (PA already exists):

J0897         Xgeva

J0897         Prolia

• Will require documentation of trial and failure of Euflexxa, Orthovisc, and Durolane (PA required as of 1 de janeiro, 2022):

J7327         Monvisc

J7325         Synvisc

J7321         Hyalgan

J7328         Gelsyn

J7321         Supartz

J7320         Genvisc

J7329         Trvisc

J7322         Hymovis

J7332         Triluron

• Will require documentation of trial and failure of Remicade, Inflectra, and Avsola (PA already exists):

Q5104       Renflexis

• Will require documentation of trial and failure of Neulasta and Udenyca (PA already exists):

Q5122       Byvepria

Q5108       Fulphila 

Q5120       Ziextenzo

• Will require documentation of trial and failure of Sandostatin LAR (PA already exists):

J1930         Somatuline Depot