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 Oct. 8, 2017.

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 Apriso, Lialda, or Pentasa.
AURYXIA Must try calcium acetate (generic PhosLo).
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 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.
EMSAM Must try a generic antidepressant.
esomeprazole Must try one generic proton pump inhibitor (PPI).
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. 
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 or EPITOL.
ONGLYZA Must first try one of Januvia, Janumet, Janumet XR, Tradjenta, Jentadueto, or Jentadueto XR.
ONZETRA XSAIL Must try sumatriptan nasal spray.
OTREXUP Must try methotrexate injection before Otexup will be approved.
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.
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, or Novolin R) before authorizing a prescription of Symlin.
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.