CurrentFidelis CarePolicy MCPB.ST.00
2026 Medicare Part B ST Criteria | Clinical Policy
Defines drugs subject to step therapy for Medicare Part B, listing required preferred agents or prior therapies by specific indication and noting that some agents may still require prior authorization. Applies to new starts (no receipt of the drug in past 365 days).
Policy Summary
PayerFidelis Care
Policy2026 Medicare Part B ST Criteria | Clinical Policy
Policy CodePolicy MCPB.ST.00
Change TypeNo material changes
Effective DateJan 1, 2021
Next Review Date
Key ActionSubmit prior authorization when required and include documentation of prior trials or reasons for exceptions (e.g., intolerance, ineligibility).
SourceLink
POLICY UPDATE CHANGES
No material changes
~100+Drugs listed with step requirements
365New start lookback period (days)
MultipleBiomarker/clinical exceptions noted
Coverage Summary & Scope
Defines drugs subject to step therapy for Medicare Part B, specifying required preferred therapeutic alternatives or prior therapies for coverage of listed Part B drugs.