2016 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 2016 Priority Health Medicare Formulary (PDF).

This list was updated June 27, 2016.

Drug name

Steps required for approval

AFREZZA

Must try HUMALOG or HUMALOG Mix.

AURYXIA

Must try calcium acetate (generic PHOSLO).

AXERT

Must try one generic triptan.

BELBUCA

Must try both methadone and morphine sulfate ER

BETASERON

Must try COPAXONE or REBIF.

CLARINEX-D

Must try levocetirizine.

CORLANOR

Must try bisoprolol, carvedilol, or metoprolol succinate.

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).

EXTAVIA

Must try COPAXONE or REBIF.

FROVA

Must try one generic triptan.

GLUMETZA

Must try metformin.

GRALISE

Must try gabapentin.

HORIZANT

Must try one of gabapentin, pramipexole and/or ropinirole.

MOVANTIK

Must try lactulose. 

MIRAPEX ER

Must try generic pramipexole.

NEUPRO

Must try one of ropinirole, ropinirole ER, or pramipexole.

NORTHERA

Must try midodrine. 

NUVESSA

Must try metronidazole vaginal gel.

ONFI

Must try one generic anticonvulsant or EPITOL.

OTREXUP

Must try methotrexate injection.

PHOSLYRA

Must try calcium acetate (generic PHOSLO).

PICATO

Must try one of imiquimod or fluorouracil.

PLEGRIDY

Must try two of the following: AVONONEX, REBIF, and/or TECFIDERA.

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.

SYMLIN

Must be using rapid-acting insulin (HUMALOG, NOVOLOG, APIDRA, HUMULIN N, NOVOLIN, NOVOLIN N, OR NOVOLIN R) concurrently with SYMLIN.

topiramate ER

Must try generic topiramate.

TREXIMET

Must try one generic triptan.

TROKENDI XR

Must try generic topiramate.

VELPHORO

Must try calcium acetate.

VRAYLAR

Must first try one of aripiprazole, clozapine, olanzapine, quetiapine, risperidone, or ziprasidone.

ZOMIG nasal spray

Must try one generic triptan.

ZONTIVITY

Must be used in combination with clopidogrel.

ZYCLARA

Must try imiquimod.