Part B Step Therapy Program - Provider Newsletter October, 2023

The current Part B step therapy program includes drugs in the Intravitreal Vascular Endothelial Growth Factor (VEGF) Inhibitors class. The 2024 list will include many additional drug classes and/or conditions. We will continue to review the list and add drugs in the future.

Our Part B drug step therapy program applies to members who are prescribed a nonpreferred drug for the first time on or after January 1, 2024. Those already on a nonpreferred drug within the previous 365 days (does not include the use of drug samples) can remain on that drug without having to try and fail the preferred drug(s) first.

All of the nonpreferred drugs and many of the preferred drugs require prior authorization. To check prior authorization requirements for Part B medications, visit our Prior Authorization & Medical Policies page and open the Medicare Advantage (MA) menu to access the code lists file.

Applicable benefit plans

Our Part B step therapy policy supports members with MA plans administered by AZ Blue. Please note: For 2024, we’re partnering with OptumCare Arizona to provide utilization management and claim/payment processing services for a subset of our HMO membership in Maricopa and Pinal counties, as indicated on the back of the ID card. Step therapy requirements may be different for these plans.

Preview the expanded step therapy policy

You can preview the 2024 Part B Step Therapy Policy now or access it via our proprietary medical policy search tool. Enter “Medicare” or “Part B” to search by keyword.

If you have questions about the Part B step therapy program, contact us at 602-864-4320 or 1-800-232-2345.

In This Issue

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October news: Executive summary

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Prosano benefit plans for employer groups for 2024

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RSV, COVID-19, and influenza vaccine coverage

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Changes to Part B Step Therapy program

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Take the #StigmaFreeAZ pledge and spread the word

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Be sure to ask, "When was your last mammogram?"

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CMS: Notifying MA enrollees of provider terminations

Get an update on the AZ 988
Crisis Response Performance

OptumCare Network of Arizona (“OptumCare Arizona”) is a separate, wholly owned subsidiary of Optum and is contracted with AZ Blue to provide utilization management and claim/payment processing services for providers and attributed members with certain AZ Blue Medicare Advantage HMO plans.

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