CurrentHealthPartnersPolicy N/A

2026 Medicare Part D Step Therapy Requirements

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Defines step therapy requirements for select prescription drugs under Medicare Part D and the conditions members must meet (prior use) to access listed products. Affects prescribers and Medicare Part D members covered by HealthPartners.

Policy Summary

PayerHealthPartners

Policy2026 Medicare Part D Step Therapy Requirements

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2026

Next Review Date

Key ActionObtain prior authorization showing prior use of the specified product (e.g., carbidopa-levodopa or tazarotene 0.1% cream) within the previous 12 months.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

12prior-use lookback period (months)

3distinct products/groups referenced

Step 2explicit step level

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CurrentHealthPartnersPolicy N/A

2026 Medicare Part D Step Therapy Requirements

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Policy Summary

PayerHealthPartners

Policy2026 Medicare Part D Step Therapy Requirements

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2026

Next Review Date

Key ActionObtain prior authorization showing prior use of the specified product (e.g., carbidopa-levodopa or tazarotene 0.1% cream) within the previous 12 months.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

12prior-use lookback period (months)

3distinct products/groups referenced

Step 2explicit step level

Step Therapy Coverage Criteria

RYTARY step therapy criteria

RYTARY products (multiple extended‑release capsule strengths):

Member must have prior use of carbidopa‑levodopa (immediate‑release or extended‑release) within the previous 12 months.

Products referenced

RYTARY 23.75 mg–95 mg extended‑release capsule
RYTARY 36.25 mg–145 mg extended‑release capsule
RYTARY 48.75 mg–195 mg extended‑release capsule
RYTARY 61.25 mg–245 mg extended‑release capsule

Tazarotene step therapy criteria

Tazarotene topical products (multiple strengths/forms):

Step 2 products

tazarotene 0.05% topical gel
tazarotene 0.05% topical cream
tazarotene 0.1% topical gel

Prior use of tazarotene 0.1% cream within the previous 12 months is required for specified tazarotene topical products.

Drug Codes, Strengths, and Lookback

RYTARY NDCs/strengths referencedNDC

RYTARY 23.75 mg–95 mg	extended-release capsule
RYTARY 36.25 mg–145 mg	extended-release capsule
RYTARY 48.75 mg–195 mg	extended-release capsule
RYTARY 61.25 mg–245 mg	extended-release capsule

Tazarotene topical strengths/formsNDC

tazarotene 0.05% topical gel	topical gel
tazarotene 0.05% topical cream	topical cream
tazarotene 0.1% topical gel	topical gel

Prior use lookback — RYTARY

Lookback period12 months

Applies toPrior use of carbidopa-levodopa immediate release or extended release

PurposeStep-therapy prior-use requirement for RYTARY products

What Providers Must Do

Prior Authorization

RYTARY prior‑use prior authorization and denial risk

Prior authorization is required for RYTARY products. The prescriber must document prior use of carbidopa‑levodopa (immediate‑release or extended‑release) within the previous 12 months; absence of that documentation may result in denial of coverage.

Document the member’s use of carbidopa‑levodopa (IR or ER) within the past 12 months.
Include dates, product names/formulations, and dispensing records or medication history to support prior use.

Prior Authorization

Tazarotene 0.1% cream prior‑use requirement and denial risk

Prior authorization for the listed tazarotene topical products requires documented prior use of tazarotene 0.1% cream within the previous 12 months; lack of this prior‑use documentation may lead to coverage denial.

Provide evidence of tazarotene 0.1% cream use within the last 12 months (e.g., prescription fill history).
If prior‑use documentation is not supplied, the request is at risk of denial under the step therapy requirement.

Definitions and Prior-Use Details

Prior use (carbidopa-levodopa) — definition for RYTARY

Definition of prior useMember must have used carbidopa-levodopa (immediate‑release or extended‑release) within the previous 12 months

Relevant productsRYTARY extended‑release capsules (23.75/95 mg; 36.25/145 mg; 48.75/195 mg; 61.25/245 mg)

Policy roleRequired condition for coverage under the RYTARY step-therapy criteria

Prior use (tazarotene) — definition

Definition of prior useMember must have used tazarotene 0.1% cream within the previous 12 months

Products impactedCertain tazarotene topical products (e.g., tazarotene 0.05% topical gel and 0.05% topical cream listed on Step 2)