Terapia escalonada con medicamentos de la Parte B

Los medicamentos de la Parte B de Medicare se encuentran cubiertos por la Parte B de Original Medicare.  MCA members can access coverage for these drugs when medically necessary. For additional coverage information about Part B drugs, please reference the Mercy Care Advantage Evidence of Coverage, Chapter 4, Benefits Chart.  

Los CMS permiten que, en los planes Medicare Advantage, se implementen los requisitos de la terapia escalonada para los medicamentos de la Parte B.  Mercy Care Advantage has implemented Step Therapy for Part B drugs and utilizes the CVS Caremark® Medical Preferred Part B Step Therapy drug list.

View the 2022 Part B Step Therapy drug list.

Providers may request prior authorization for Medicare Part B drugs when medically necessary. Providers may also request prior authorization for a member to use a non-preferred Part B drug instead of the Preferred Part B Step Therapy drug. For this situation the provider will need to include a supporting statement. This situation typically applies when a member is already in an active course of treatment. Prior authorization requests for Part B drugs will be reviewed and processed within 24 hours for an expedited request and 72 hours for a standard request.


Última actualización: 6/22/2022