Part B Step Therapy List

Biosimilars-first Medical Preferred Drug List
Medicare Part B Step Therapy

The CVS Caremark® Biosimilars-first Medical Preferred Drug List encourages utilization of clinically appropriate and lower net cost products within the following therapeutic drug classes. The CVS Caremark Biosimilars-first Medical Preferred Drug List applies to the listed products only and any other product may be available under a plan’s medical benefit.

The listed preferred products must be used first. An exception process is in place for specific circumstances that may warrant a need for a non-preferred product. For example, this step therapy requirement does not apply to plan’s members who are actively receiving treatment (i.e., members with a paid claim within the past 365 days) with non-preferred product on the CVS Caremark Biosimilars-first Medical Preferred Drug List.

Drug Class Non-Preferred Product(s)* Preferred Product(s)
Acromegaly Signifor LAR
Somavert
Sandostatin LAR
Somatuline Depot
Alpha-1 Antitrypsin Deficiency Aralast
Glassia
Zemaira
Prolastin-C
Autoimmune Actemra
Cimzia
Ilumya
Remicade
Orencia
Stelara
Avsola
Entyvio
Inflectra
Renflexis
Simponi Aria
Bevacizumab Avastin Mvasi
Zirabev
Botulinum Toxins Botox
Myobloc
Dysport
Xeomin
Hematologic, Erythropoiesis –Stimulating Agents (ESA) Epogen
Mircera
Procrit
Aranesp
Retacrit
Hematologic, Neutropenia Colony Stimulating Factors – Short Acting Granix
Leukine
Neupogen
Nivestym
Zarxio
Hematologic, Neutropenia Colony Stimulating Factors – Long Acting Neulasta Fulphila
Nyvepria
Udenyca
Ziextenzo
Lysosomal Storage Disorders – Gaucher Disease Cerezyme
VPRIV
Elelyso
Multiple Sclerosis (Infused) Lemtrada Tysabri
Multiple Sclerosis (Infused) Lemtrada Tysabri
Osteoarthritis, Viscosupplements – Single Injection Durolane
Gel-One
Monovisc
Synvisc-One
Osteoarthritis, Viscosupplements – Multi Injection Euflexxa
Gelsyn-3
GenVisc
Hyalgan
Hymovis
TriVisc
Visco-3
Orthovisc
Synvisc
Prostate Cancer – Luteinizing Hormone Releasing Hormone (LHRH) Antagonists Agents   OFirmagon
Prostate Cancer – Luteinizing Hormone Releasing Hormone (LHRH) Agents Lupron Depot
Trelstar
Zoladex
Eligard
Retinal Disorders Agents Beovu
Eylea
Lucentis
Avastin
Rituximab Rituxan Riabni
Rituxan Hycela
Ruxience
Truxima
Severe Asthma Cinqair Fasenra
Nucala
Xolair
Trastuzumab Herceptin Herzuma
Herceptin Hylecta
Kanjinti
Ogivri
Ontruzant
Trazimera