Medicare Part B Step Therapy Vegzelma

New specialty pharmacy medical step therapy requirements

Effective June 1, 2023, the following Part B medications from the current Clinical Criteria guidelines will be included in our medical step therapy precertification review process. 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 medications listed below.

Clinical Criteria guidelines are publicly available on the provider website. Visit the Clinical Criteria page to search for specific criteria.