2026 Medicare Part D Step Therapy Requirements
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This document governs Step Therapy requirements in the HealthPartners Part D Formulary affecting beneficiaries and prescribers, specifying prior-use criteria for listed drugs effective April 1, 2026.
No material clinical or coverage changes in this revision.
Step Therapy Coverage Criteria
RYTARY Step 2 criteria
Covered as Step 2 when ALL of the following are met:
ALL of the following
- Documented prior use of carbidopa-levodopa immediate release or extended release tablets within the previous 12 months
Prior use lookback period: 12 months
Tazarotene topical Step 2 criteria
Covered as Step 2 when ALL of the following are met:
ALL of the following
- Documented prior use of tazarotene 0.1% cream within the previous 12 months
Prior use lookback period: 12 months
Drug Codes and Lookback Period
| CARBIDOPA ER 23.75 MG-LEVODOPA 95 MG | CARBIDOPA ER 23.75 MG-LEVODOPA 95 MG CAPSULE, EXTENDED RELEASE |
| CARBIDOPA ER 36.25 MG-LEVODOPA 145 MG | CARBIDOPA ER 36.25 MG-LEVODOPA 145 MG CAPSULE, EXTENDED RELEASE |
| tazarotene 0.05% cream | tazarotene 0.05 % topical cream |
| tazarotene 0.05% gel | tazarotene 0.05 % topical gel |
| tazarotene 0.1% cream | tazarotene 0.1 % topical cream (referenced for prior-use) |
| tazarotene 0.1% gel | tazarotene 0.1 % topical gel (referenced for prior-use) |
Required Provider Actions and Prior-Use Rules
RYTARY Step 2 prior‑use prior authorization
Prior authorization / Step Therapy: Document prior use of carbidopa‑levodopa immediate‑release or extended‑release tablets within the previous 12 months for RYTARY (carbidopa ER/levodopa ER) to meet Step 2 requirements. Approvals are contingent on documentation of that prior use; absence of prior use may result in denial or requirement to complete the step.
- Products affected: CARBIDOPA ER 23.75 mg‑LEVODOPA 95 mg capsule, extended release; CARBIDOPA ER 36.25 mg‑LEVODOPA 145 mg capsule, extended release.
- Required lookback period: prior use within the previous 12 months.
Tazarotene 0.05% topical — prior‑use requirement
Prior authorization / Step Therapy: For tazarotene 0.05% topical cream or gel (Step 2), document prior use of tazarotene 0.1% cream within the previous 12 months to satisfy the Step 2 prior‑use requirement.
- Required lookback period: prior use within the previous 12 months.
- Affected products: tazarotene 0.05% topical cream and gel; prior‑use reference is tazarotene 0.1% cream.
Definitions
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