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.