2026 Medicare Part D Step Therapy Requirements
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.
No material clinical or coverage changes in this revision.
Step Therapy Coverage Criteria
RYTARY step therapy criteria
RYTARY products (multiple extended‑release capsule strengths):
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
Drug Codes, Strengths, and Lookback
| 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 0.05% topical gel | topical gel |
| tazarotene 0.05% topical cream | topical cream |
| tazarotene 0.1% topical gel | topical gel |
What Providers Must Do
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.
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
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