Clinical Policy: Step Therapy
Defines drugs and indications subject to step therapy requirements for Fidelis Care Medicare Part B members, listing preferred agents that must be tried before non-preferred agents are approved and noting instances where prior authorization may be required.
Policy provides an updated comprehensive list of Part B agents subject to step therapy and their required preferred step agents or exceptions.
What is Changing
This policy clarifies and updates a comprehensive list of Medicare Part B drugs that are subject to step therapy, identifying preferred agents (often biosimilars or lower-cost alternatives) that must be tried prior to coverage of non-preferred agents for specific indications. The policy enumerates many individual agents with indication-specific step requirements and exceptions, and reminds reviewers that some intravenous chemotherapy regimens may not require prior authorization.
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.