Oakland Southfield Physicians

OSP News

Priority Health Announces Step Therapy Added for Some Medicare Part B Drugs

Posted: 08/12/2019

Effective October 1, 2019, before prescribing a new start for a medication on the step therapy requirement list, providers must first receive prior authorization and proceed through the required steps. While these drugs do not currently have a prior authorization in place under Medicare Part B, they have prior authorization in place under our commercial and/or Medicare Part D formularies.

What is step therapy?

Step therapy requires a member to first try certain drugs to treat their medical condition before we’ll cover another drug for that condition. For example, if Drug A and Drug B both treat a medical condition, we may not cover Drug B unless they try Drug A first. If Drug A does not work, we’ll then cover Drug B. 

Why we’re adding step therapy

Step therapy ensures our members are getting the care they need at the right price. Drug costs affect all patients, including those with Medicare. Step therapy gives patients options that might save them money while still getting the care they need.

Impact to members

Members already receiving a drug on this list will be exempt from the new step therapy requirement and will be able to continue their current drug. If a member is new to Priority Health from another health plan and was previously taking a drug on the step therapy required list, they are exempt as they are not technically a new start to that drug. 

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