2026 Medicare Part D Step Therapy Requirements
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Specifies Part D step therapy (prior use) requirements for certain branded and generic drug products on the HealthPartners Part D formulary; applies to Medicare Part D beneficiaries under the HealthPartners plan.
No material clinical or coverage changes in this revision.
Coverage Criteria
RYTARY — Step 2 requirement
Covered when ALL of the following are met
Applies to listed ER capsule strengths
Tazarotene topical — Step 2 requirement
Covered when ALL of the following are met
Applies to listed tazarotene topical formulations
No explicit exclusions are listed in this policy document.
The policy does not list any conditions that would render these products not medically necessary. Instead, coverage for the listed Step 2 products is contingent on prior-use (step therapy) requirements described in the criteria.
Coding / Affected Products
| CARBIDOPA ER 23.75 MG-LEVODOPA 95 MG | capsule, extended release (RYTARY product affected) |
| CARBIDOPA ER 36.25 MG-LEVODOPA 145 MG | capsule, extended release |
| CARBIDOPA ER 48.75 MG-LEVODOPA 195 MG | capsule, extended release |
| CARBIDOPA ER 61.25 MG-LEVODOPA 245 MG | capsule, extended release |
| tazarotene 0.05% topical cream | topical cream |
| tazarotene 0.05% topical gel | topical gel |
| tazarotene 0.1% topical gel | topical gel |
Provider Actions & Documentation
Prior-use required (12-month lookback)
Prior use of the specified comparator product within the previous 12 months is required before coverage of the Step 2 products.
Step 2 prior-use requirement (drug-specific)
Coverage of Step 2 formulations requires documented prior use of the designated lower-step products: for RYTARY ER capsules, prior use of carbidopa-levodopa immediate‑release OR extended‑release tablets within the previous 12 months; for the listed tazarotene topical products, prior use of tazarotene 0.1% cream within the previous 12 months.
- RYTARY: prior use of carbidopa‑levodopa immediate‑release or extended‑release tablets within the previous 12 months.
- Tazarotene topical products: prior use of tazarotene 0.1% cream within the previous 12 months.
Evidence of prior therapy required in request
Documentation submitted for authorization must demonstrate prior use of the specified comparator therapy within the previous 12 months — e.g., evidence of use of immediate‑release or extended‑release carbidopa‑levodopa for RYTARY or tazarotene 0.1% cream for tazarotene topical products.
- Show dates or records confirming use within the previous 12 months.
- Specify which comparator product was used (immediate‑release vs extended‑release carbidopa‑levodopa; tazarotene 0.1% cream).
Denial risk if prior use not documented
Failure to document prior use of the specified comparator product within the previous 12 months may result in denial of coverage under the step therapy rules for the listed Step 2 products.
Step Therapy Rules
| Step | Requirement | Lookback period |
|---|---|---|
| Step 2 | Prior documented use of the specified comparator product (for RYTARY: carbidopa-levodopa immediate‑release OR extended‑release tablets; for tazarotene topical products: tazarotene 0.1% cream) is required before coverage of the Step 2 products. | 12 months (within the previous 12 months) |
Definitions
Background
This policy sets Part D step therapy (prior-use) requirements for select formulary drugs. For the listed Step 2 products, coverage requires documented prior use of the designated comparator product within the previous 12 months (for example, prior use of carbidopa‑levodopa immediate‑release or extended‑release tablets for RYTARY formulations, or prior use of tazarotene 0.1% cream for listed tazarotene topical products). Documentation of that prior therapy must be provided to support coverage.
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