Medicare AdvantageOctober 1, 2021
New medical step therapy requirements
Effective November 1, 2021, the Clinical Criteria ING-CC-0005 will include a trial and inadequate response or intolerance to two preferred hyaluronan agents in the Part B medical step therapy precertification review. Step therapy review will apply upon precertification initiation, in addition to the current medical necessity review (as-is current procedure). Step therapy will not apply for members who are actively receiving non-preferred medications listed below.
Clinical Criteria are publicly available on the provider website. Visit the Clinical Criteria page to search for specific criteria.
|
Clinical Criteria |
Preferred drug(s) |
Nonpreferred drug(s) |
|
ING-CC-0005 |
Euflexxa (J7323) Supartz FX (J7321) Durolane (J7318) Gelsyn-3 (J7328) |
Including but not limited to:
|
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