Step therapy requirements for select Part D drugs
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Defines step therapy (prior authorization alternative therapy sequencing) requirements for specific drugs on Independent Health's Medicare Advantage Part D formularies; affects prescribers and pharmacy benefit administrators for Medicare Advantage members.
No material clinical or coverage changes in this revision.
Step Therapy / Initial Coverage Criteria
Initial step therapy requirements
Covered only after failure or trial of specified first-line agent(s):
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Aliskiren
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Aripiprazole
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EUCRISA
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Febuxostat
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Sympazan
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Trelstar
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Versacloz
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Doxercalciferol
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Provider Notices and Actionable Product Sequencing
Member contact and notices
This list is current as of 2026-06-01 and pertains to Independent Health Medicare Advantage Part D formularies. In some cases, we require that a member try certain drugs first (step therapy) before we will cover another drug for the same condition. If you have questions, contact Medicare Member Services at 1-800-665-1502 (TTY 711). October 1 - March 31: daily 8 a.m. - 8 p.m.; April 1 - September 30: Monday - Friday 8 a.m. - 8 p.m. The formulary may change at any time; members will receive notice when necessary.
EUCRISA step requirement
EUCRISA (crisaborole) ointment requires that the member first try a topical corticosteroid or a topical calcineurin inhibitor prior to coverage under the Part D formulary.
- Applies to EUCRISA ointment (topical crisaborole).
- Step therapy: trial of a topical corticosteroid OR a topical calcineurin inhibitor required before coverage.
Febuxostat step requirement
Febuxostat (both 40 mg and 80 mg formulations) requires prior use of allopurinol before coverage will be approved under the Part D formulary.
- Applies to febuxostat tablets (including 80 mg).
- Step therapy: trial of allopurinol required prior to approval.
SYMPAZAN step requirement
SYMPAZAN oral films require that the member first try clobazam oral suspension prior to coverage under the Part D formulary.
- Applies to SYMPAZAN films (e.g., 5 mg).
- Step therapy: trial of clobazam oral suspension required before coverage.
Doxercalciferol step requirement
Doxercalciferol 2.5 mcg capsule requires prior use of calcitriol before coverage is approved under the Part D formulary.
- Applies to doxercalciferol capsule 2.5 mcg.
- Step therapy: trial of calcitriol required prior to coverage.
Required First-Line Agents and Sequencing Table
| Drug | Step therapy requirement | Coverage status |
|---|---|---|
| Aliskiren fumarate tablet 300 mg oral | ||
| Requires prior trial of an angiotensin‑II receptor blocker (ARB) | ||
| Covered with criteria |
| Drug | Step therapy requirement | Coverage status |
|---|---|---|
| Aripiprazole orally‑disintegrating tablet (ODT) | ||
| Requires prior use of aripiprazole oral solution before ODT; aripiprazole oral films require prior use of ODT | ||
| Covered with criteria |
| Drug | Step therapy requirement | Coverage status |
|---|---|---|
| EUCRISA ointment | ||
| Requires prior use of either a topical corticosteroid OR a topical calcineurin inhibitor | ||
| Covered with criteria |
| Drug | Step therapy requirement | Coverage status |
|---|---|---|
| Febuxostat tablet 40 mg and 80 mg | ||
| Requires prior use of allopurinol | ||
| Covered with criteria |
| Drug | Step therapy requirement | Coverage status |
|---|---|---|
| SYMPAZAN film (all strengths) | ||
| Requires prior use of clobazam oral suspension | ||
| Covered with criteria |
| Drug | Step therapy requirement | Coverage status |
|---|---|---|
| TRELSTAR MixJect formulations (reconstituted) | ||
| Requires prior use of Lupron Depot | ||
| Covered with criteria |
| Drug | Step therapy requirement | Coverage status |
|---|---|---|
| VERSACLOZ suspension 50 mg/mL oral | ||
| Requires prior use of clozapine orally‑disintegrating tablet (ODT) | ||
| Covered with criteria |
| Drug | Step therapy requirement | Coverage status |
|---|---|---|
| Doxercalciferol capsule 2.5 mcg oral | ||
| Requires prior use of calcitriol | ||
| Covered with criteria |
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