Effective 03/01/2026, Baylor Scott & White Health Plan updated Medicare Part B Step Therapy Policy (Policy 307) to add and remove multiple therapeutic classes and clarify step therapy rules. The ophthalmic VEGF inhibitor class is now defined specifically for ophthalmic indications, with Avastin designated as Preferred and agents including Beovu, Byooviz, Eylea (regular and HD), Lucentis, Pavblu, Susvimo and Vabysmo listed as Non‑Preferred for ophthalmic use. The policy clarifies that step therapy requirements apply to all preferred drugs under the policy and that coverage determinations for other Medicare outpatient drugs are handled per referenced BSWHP policies. The revision log (through 02/26/2026) documents iterative class additions (e.g., Trop‑2 agents, PD‑1 inhibitors) and removals (notably methotrexate), reflecting active maintenance of the step therapy framework.
03/01/2026 Revision: Class Additions, Removals, and Step Therapy Clarification
This revision, effective 03/01/2026, documents multiple updates through 02/26/2026 and includes specific class additions and removals within the Step Therapy Policy for Medicare Part B (Policy Number: 307). The change log lists incremental updates: additions of drug classes (e.g., Pavblu to ophthalmic VEGF inhibitor class), clarifications that step therapy applies to all preferred drugs, inclusion of several biosimilars and therapeutic classes (e.g., denosumab biosimilars for Xgeva, Trop-2 directed antibody agents), and removal of certain classes (e.g., removal of methotrexate class as of 02/26/2026).
Ophthalmic VEGF Inhibitor Class: Preferred vs Non-Preferred Agents
The policy explicitly defines a therapeutic class for ophthalmic VEGF inhibitors and distinguishes Preferred and Non-Preferred agents for ophthalmic indications only. Preferred agent listed is Avastin. Non-Preferred agents named for ophthalmic use include Beovu, Byooviz, Eylea (regular and HD), Lucentis, , and . Separately, and other ophthalmic VEGF inhibitor–containing agents are denoted as Non-Preferred in another passage of the document.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.