CurrentHealthPartnersPolicy N/A

2026 Medicare Part D Step Therapy Requirements

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.

Policy Summary

PayerHealthPartners

Policy2026 Medicare Part D Step Therapy Requirements

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJun 1, 2026

Next Review DateN/A

Key ActionRequire documentation of prior use of the specified lower-step therapy within the previous 12 months before approving Step 2 products.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2distinct product groups with step therapy rules listed

12 morequired prior-use lookback period

4listed ER carbidopa-levodopa strengths

Step Therapy Coverage Criteria

Carbidopa-levodopa ER step criteria

Rytary / carbidopa-levodopa ER products (Step 2)

Prior use of carbidopa-levodopa immediate-release or extended-release tablets within the previous 12 months

Medication history or prescription records must document use within the prior 12 months.

Tazarotene step criteria

Tazarotene topical products (Step 2)

Prior use of tazarotene 0.1% cream within the previous 12 months

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

Index of listed product strengthsNDC

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

Policy Summary

PayerHealthPartners

Policy2026 Medicare Part D Step Therapy Requirements

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJun 1, 2026

Next Review DateN/A

Key ActionRequire documentation of prior use of the specified lower-step therapy within the previous 12 months before approving Step 2 products.

SourceLink

On This Page

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.

What Providers and Pharmacy Teams Must Do

Step Therapy

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

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

OpenPayer

2026 Medicare Part D Step Therapy Requirements

Step Therapy Coverage Criteria

Product Index and Coding Details

What Providers and Pharmacy Teams Must Do

Key Definitions