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Step therapy requirements for Medicare outpatient (Part B) medications

 

Effective May 1, 2019, Security Health Plan implemented step therapy requirements for people who are prescribed any of the drugs listed in the table below for the first time. Step therapy prior authorization will be managed through our specialty pharmacy medication partner, Magellan (1-800-424-8243, spcustomer.magellanprovider.com).

Step therapy is the process of trying lower-priced drugs before taking a “step up” to one that is more expensive, in an effort to reduce the cost of care.

Step therapy will be required if the following conditions are met:

Requested drug

Preferred alternative drug

Epogen/Procrit (J0885)

Retacrit (Q5106)

Eylea(J0178)
Lucentis (J2778)
Macugen (J2503)

Avastin (C9257)