2018 list of Medicare drugs requiring step therapy
Some drugs will be approved for you only after you try other drugs first and they don't work for you. This approval requirement is called "step therapy," and the drugs that it applies to are called "step therapy drugs."
Step therapy drugs are identified in the 2018 Priority Health Medicare Formulary (PDF).
This list was updated June 25, 2018.
Drug name | Steps required for approval |
AFREZZA | Must first try Humalog or Humalog Mix. |
APIDRA | Must first try Humalog or Humalog Mix. |
ASACOL HD | Must first try one of mesalamine, Apriso, Lialda, or Pentasa. |
BASAGLAR | Must first try Lantus or Toujeo. |
BELBUCA | Must first try one of methadone or morphine sulfate ER. |
CLARINEX-D | Must try levocetirizine. |
CORLANOR | Must try bisoprolol, carvedilol, or metoprolol succinate. |
DELZICOL | Must first try one of mesalamine, Apriso, Lialda, or Pentasa. |
desvenlafaxine ER | Must try one of venlafaxine (generic EFFEXOR), venlafaxine ER (generic EFFEXOR XR), or duloxetine (generic CYMBALTA). |
DEXILANT | Must try two generic proton pump inhibitors (PPIs). |
DIFICID | Must try vancomycin. |
eletriptan | Must try one of sumatriptan, rizatriptan, or naratriptan. |
EMSAM | Must try a generic antidepressant. |
esomeprazole | Must try one generic proton pump inhibitor (PPI). |
FIASP® | Must first try Humalog or Humalog Mix. |
GRALISE | Must try gabapentin. |
HORIZANT | Must first try gabapentin, pramipexole or ropinirole. |
INVOKAMET | Must first try one of Jardiance, Synjardy, Farxiga, or Xigduo XR. |
INVOKAMET XR | Must first try one of Jardiance, Synjardy, Farxiga, or Xigduo XR. |
INVOKANA | Must first try one of Jardiance, Synjardy, Farxiga, or Xigduo XR. |
KOMBIGLYZE XR | Must first try one of Januvia, Janumet, Janumet XR, Tradjenta, Jentadueto, or Jentadueto XR. |
LEVEMIR | Must first try Lantus or Toujeo. |
MOVANTIK | Must try lactulose. |
NEUPRO | Must try one of ropinirole, ropinirole ER, or pramipexole. |
NORTHERA | Must try midodrine. |
NOVOLIN | Must first try Humulin R, Humulin N, or Humulin 70/30. |
NOVOLOG | Must first try Humalog or Humalog Mix. |
NUVESSA | Must try metronidazole vaginal gel. |
ONFI | Must try one generic anticonvulsant, Cerebyx, Roweepra, or Epitol. |
ONGLYZA | Must first try one of Januvia, Janumet, Janumet XR, Tradjenta, Jentadueto, or Jentadueto XR. |
ONZETRA XSAIL | Must try sumatriptan nasal spray or auto-injector. |
OTREXUP | Must try methotrexate injection before Otexup will be approved. |
OZEMPIC | Must first try one of Trulicity, Bydureon or Byetta. |
PANCREAZE | Must first try Creon. |
PHOSLYRA | Must try calcium acetate (generic PhosLo). |
PICATO | Must try one of imiquimod or fluorouracil. |
QUDEXY XR | Must try generic topiramate. |
RASUVO | Must try methotrexate, either injection or oral tablets. |
RAYOS | Must try one generic oral corticosteroid. |
RELPAX | Must try one generic triptan. |
RYTARY | Must try carbidopa-levodopa ER. |
SEGLUROMET | Must first try one of Jardiance, Synjardy, Farxiga, or Xigduo XR. |
STEGLATRO | Must first try one of Jardiance, Synjardy, Farxiga, or Xigduo XR. |
sumatriptan and naproxen | Must have a trial with one generic triptan. |
SUMAVEL DOSEPRO | Must try one generic triptan or Onzetra Xsail. |
SYMLIN | Confirms concurrent use of rapid-acting insulin (Humalog, Humalog Mix, Novolog, Novolog Mix, Apidra, Humulin N, Humulin R, Humulin 70/30, Novolin, Novolin N, Novolin R, or Fiasp) before authorizing a prescription of Symlin. |
SYMPROIC | Must first try lactulose. |
TANZEUM | Must first try one of Byetta, Bydureon, or Trulicity. |
topiramate ER | Must try generic topiramate. |
TREXIMET | Must try one generic triptan. |
TROKENDI XR | Must try generic topiramate. |
VELPHORO | Must try calcium acetate. |
VICTOZA | Must first try one of Byetta, Bydureon, or Trulicity. |
VRAYLAR | Must first try one of aripiprazole, clozapine, olanzapine, quetiapine, risperidone, or ziprasidone. |
ZENPEP | Must first try Creon. |
ZOMIG nasal spray | Must try one generic triptan. |
ZONTIVITY | Must be taking clopidogrel in combination with Zontivity. |
ZYCLARA | Must try imiquimod. |