Providence Medicare Advantage Plans 2026 Step Therapy Criteria for Part B Drugs (drug list / step therapy protocols)
Lists Medicare Part B medications subject to the plan's step therapy requirements and notes general rules for step therapy, prior authorization, and exemptions (e.g., prior use within 365 days). Each listed drug includes HCPCS/J-codes and links to individual policy criteria; some entries list an effective date if after 1/1/2026.
Document lists the Medicare Part B drugs subject to step therapy and explains general rules including 365-day prior-use exemption and requirement for prior authorization for Step 2 and Step 3 drugs.
Summary of changes and at-a-glance stats
Providence Medicare Advantage Plans maintains a consolidated step therapy protocol for Medicare Part B–administered drugs that requires trial of a Step 1 (preferred) agent before covering Step 2/Step 3 (non‑preferred) agents; the list applies to Medicare Part B medications and links each HCPCS/J‑code to its individual policy criteria. There is a 365‑day prior‑use exemption (the step requirement does not apply if the member received the non‑preferred drug within the past 365 days), and step requirements integrate with prior authorization and quantity limits (Step 2 and Step 3 always require prior authorization; Step 1 usually does unless noted).
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