Generations Advantage Part B Step Therapy for Drugs & Biologics Begins January 1, 2022
- Only non-preferred products will require prior authorization. Product-specific drug authorization request forms are now available. These forms should be completed and submitted with your request along with supporting medical records.
- For members who’ve already received treatment with a non-preferred product within the past 365 days, step therapy requirements do not apply but prior authorization is still required. On the drug-specific authorization form there is a checkbox to indicate prior use of the non-preferred product.
- NDCs are required on ALL (preferred and non-preferred) step therapy drug claims and on some authorization request forms.
- Authorization requests for non-preferred products can be submitted now for services in January 2022.
- Avastin (bevacuzimab) is preferred for ocular conditions and non-preferred for cancer indications. Authorization is only required for non-ocular-related treatments.
- When the same HCPCS code (i.e., J0256 or J9217) is used for a preferred and non-preferred product, the NDC will be used to determine authorization requirement for that code in the claims system. The NDC will be required on the authorization form.
- Unlisted codes require prior authorization when used for a preferred product.
- Authorization requests for non-preferred products can be submitted now for services in January 2022
For a list of preferred drugs please see our Part B Step Therapy Drug List (PDF)
Drug-Specific Authorization Forms (fill out and submit with your request)