Medicare Part B Prior Authorization and Step Therapy
Select Part B drugs require Prior Authorization before they can be administered. The approval or denial is based on the plan design and focuses on safety and proper medication use.
In addition, some Part B drugs will require Step Therapy, a form of utilization management that requires you to first try a preferred drug to treat a medical condition before we will cover another, non-preferred drug for that condition. Drugs that require step therapy are marked with an "ST" in the Medicare Part B Prior Authorization List below.
Part B Prior Authorization List (effective 01/01/2026)
Part B Step Therapy (effective 01/01/2026)
Part B Prior Authorization Criteria
When evaluating coverage requests for Part B drugs, MercyOne Health Plan follows National Coverage Determinations for all drugs on our Part B Prior Authorization List except for those listed below, which include plan-specific criteria.
Select a drug name below to review prior authorization criteria. Drugs are listed in alphabetical order.