Products & Programs PharmacyMedicare AdvantageApril 16, 2025

New specialty pharmacy medical step therapy requirement

Effective June 1, 2025, the following Medicare Part B medication from the current Clinical Criteria Guidelines will be included in our medical step therapy preapproval review process. Step therapy review will apply upon preapproval initiation in addition to the current medical necessity review (as is current procedure). Step therapy will not apply for members who are actively receiving the medication listed below.

Visit our Clinical Criteria page to search for specific criteria.

Clinical Criteria

Drug

Status

CC‑0166

Hercessi (trastuzumab‑strf)

Non‑preferred

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MULTI-BC-CR-077569-25-CPN77133

PUBLICATIONS: May 2025 Provider Newsletter