Wellcare 2024 Medicare Part B Step Therapy Drugs

Date: 11/21/23

Fort Lauderdale, Florida

Wellcare’s Step Therapy programs are a safe and effective method for reducing treatment costs by ensuring that members undergo an adequate trial of a safe, proven and cost-effective therapy before “stepping up” to less cost-effective options.

These first-line drugs are recognized as safe and economically sound treatments. The drugs listed below will require step therapy starting January 1, 2024.

Step therapy is failure of at least one different or less expensive drug prior to coverage of a drug on this list. The prescriber, patient, or the patient’s authorized representative may ask for an exception.

Step therapy applies if:

At least one other or less expensive drug fails to alleviate the member’s condition.
The drug has not been used in the past 365 days.

Drug Names

Abatacept (Orencia®)
Ado-trastuzumab emtansine (Kadcyla®)
Aflibercept (Eylea®)
Atezolizumab (Tecentriq®)
Axicabtagene ciloleucel (Yescarta®)
Bevacizumab (Avastin®, Alymsys®, Mvasi®, Vegzelma™, Zirabev™)
Brentuximab vedotin (Adcetris®)
Brexucabtagene autoleucel (Tecartus™)
Brolucizumab-dbll (Beovu®)
Cemiplimab-rwlc (Libtayo®)
Certolizumab (Cimzia®)
Ciltacabtagene autoleucel (Carvykti™)
Corticosteroid intravitreal implants: dexamethasone (Ozurdex®), fluocinolone acetonide (Iluvien®, Retisert®, Yutiq™)
Corticotropin (H.P. Acthar®, Purified Cortrophin™ Gel)
Daratumumab (Darzalex®), daratumumab/hyaluronidase-fihj (Darzalex Faspro™)
Darbepoetin alfa (Aranesp®)
Denosumab (Xgeva®)
Durvalumab (Imfinzi®)
Eflapegrastim-xnst (Rolvedon™)
Elotuzumab (Empliciti®)
Emapalumab-lzsg (Gamifant™)
Epoetin alfa (Epogen®, Procrit®)
Faricimab-svoa (Vabysmo™)
Ferric carboxymaltose (Injectafer®)
Ferric derisomaltose (Monoferric®)
Ferric pyrophosphate (Triferic®, Triferic Avnu®)
Ferumoxytol (Feraheme®)
Filgrastim (Neupogen®, Zarxio®, Nivestym™, Granix®, Releuko®)
Golimumab (Simponi®, Simponi Aria®)
Hyaluronate derivatives: sodium hyaluronate (Euflexxa®, Gelsyn-3™, GenVisc®850, Hyalgan®, Supartz FX™, Synojoynt™, Triluron™, TriVisc™, VISCO-3™), hyaluronic acid (Durolane®), cross-linked hyaluronate (Gel-One®), hyaluronan (Hymovis®, Orthovisc®, Monovisc®), hylan polymers A and B (Synvisc®, Synvisc One®)
Idecabtagene vicleucel (Abecma™)
Immune globulins (Asceniv™, Bivigam®, Cutaquig®, Cuvitru™, Flebogamma® DIF, GamaSTAN®, GamaSTAN® S/D, Gammagard® liquid, Gammagard S/D, Gammaked™, Gammaplex®, Gamunex®-C, Hizentra®, HyQvia®, Octagam®, Panzyga®, Privigen®, Xembify®)
IncobotulinumtoxinA (Xeomin®)
Lisocabtagene maraleucel (Breyanzi®)
Lurbinectedin (Zepzelca™)
Luspatercept-aamt (Reblozyl®)
Lutetium Lu 177 dotatate (Lutathera®)
Nadofaragene firadenovec-vncg (Adstiladrin®)
Natalizumab (Tysabri®)
Nivolumab (Opdivo®)
Pegfilgrastim (Neulasta®, Fulphila™, Fylnetra®, Nyvepria™, Stimufend®, Udenyca™, Ziextenzo™)
Pembrolizumab (Keytruda®)
Polatuzumab vedotin-piiq (Polivy™)
Ramucirumab (Cyramza®)
Ranibizumab (Lucentis®, Byooviz®, Cimerli™, Susvimo™)
RimabotulinumtoxinB (Myobloc®)
Rituximab (Rituxan®, Riabni™, Ruxience™, Truxima®), rituximab/hyaluronidase (Rituxan Hycela™)
Romiplostim (Nplate®)
Romosuzumab-aqqg (Evenity™)
Sargramostim (Leukine®)
Sipuleucel-T (Provenge®)
Teclistamab-cqyv (Tecvayli®)
Teprotumumab-trbw (Tepezza™)
Tisagenlecleucel (Kymriah®)
Tocilizumab (Actemra®)
Trastuzumab (Herceptin®, Ontruzant®, Herzuma®, Ogivri™, Trazimera™, Kanjinti™), trastuzumab/hyaluronidase (Herceptin Hylecta™)
Triamcinolone ER injection (Zilretta®)
Triamcinolone acetonide suprachoroidal injection (Xipere™)
Vedolizumab (Entyvio®)
Verteporfin (Visudyne®)

Questions?

If you have questions, please contact your Provider Engagement Administrator, call Wellcare Provider Services at 1-855-538-0454 or visit Wellcare.com/Florida. Stay up to date on Wellcare provider notices by reviewing and bookmarking Provider Bulletins.

^WC_7045