Back to Insights and Updates for ProvidersOctober 2023

2024 Part B Step Therapy program

Harvard Pilgrim Stride (HMO) Medicare Advantage  |  Tufts Health Plan Senior Care Options  |  Tufts Health Unify  |  Tufts Medicare Preferred

Effective for fill dates on or after Jan. 1, 2024, the following coverage requirements will apply to the Part B Step Therapy program for Harvard Pilgrim StrideSM (HMO)/(HMO-POS) Medicare Advantage, Tufts Medicare Preferred, Senior Care Options, and Tufts Health Unify.

The following new categories will be added to the Part B Step Therapy program:

  • Acromegaly
    • Antiemetics
    • Bone Resorption Inhibitors
    • Botulinum Toxins
  • The following existing categories will be updated:
    • Gaucher’s Disease
    • Leucovorin/LEVOleucovorin Injection
    • Trastuzumab – Ogivri will be a non-preferred trastuzumab product. Kanjinti and Trazimera will be the preferred trastuzumab products.

For more information, refer to the updated Medicare Part B Step Therapy Medical Necessity Guidelines (Harvard Pilgrim, Tufts Health Plan).

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