2026 Medicare Part D Step Therapy Requirements
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This document lists step therapy requirements for specific Part D drugs (notably Rytary/carbidopa-levodopa ER formulations and topical tazarotene) and the prior-use criteria required for coverage. It affects Medicare Part D beneficiaries and pharmacy/drug benefit administrators implementing step edits.
No material clinical or coverage changes in this revision.
Step Therapy Coverage Criteria
Carbidopa-levodopa ER step criteria
Rytary / carbidopa-levodopa ER products (Step 2)
Medication history or prescription records must document use within the prior 12 months.
Tazarotene step criteria
Tazarotene topical products (Step 2)
Medication or prescription history must document prior use within 12 months; applies to listed 0.05% cream/gel Step 2 products.
Product Index and Coding Details
| CARBIDOPA ER 23.75 MG-LEVODOPA 95 MG CAPSULE,EXTENDED RELEASE | |
| 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 | |
| tazarotene 0.05 % topical gel | |
| tazarotene 0.1 % topical gel |
What Providers and Pharmacy Teams Must Do
Step Therapy — Rytary (carbidopa‑levodopa ER)
Step Therapy — Rytary (carbidopa‑levodopa ER): Step 2 Rytary products require documentation of prior use of carbidopa‑levodopa immediate‑release or extended‑release tablets within the previous 12 months. If prior use is not documented, coverage may be denied or prior authorization may be required.
- Products affected Step 2: CARBIDOPA ER 23.75 MG‑LEVODOPA 95 MG CAPSULE, EXTENDED RELEASE
- Products affected Step 2: CARBIDOPA ER 36.25 MG‑LEVODOPA 145 MG CAPSULE, EXTENDED RELEASE
Step Therapy — Tazarotene topical
Step Therapy — Tazarotene topical: Step 2 tazarotene products require documentation of prior use of tazarotene 0.1% cream within the previous 12 months.
- tazarotene 0.1% topical gel
Key Definitions
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