2017 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 2017 Priority Health Medicare Formulary (PDF).

This list was updated Nov. 2, 2016.

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).
BELBUCA  Must first try one of methadone or morphine sulfate ER.
BETASERON  Must first try Glatopa or Rebif. 
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).
EXTAVIA  Must first try Glatopa or Rebif. 
GLUMETZA Must try metformin.
GRALISE Must try gabapentin.
HORIZANT Must first try gabapentin, pramipexole or ropinirole.
MIRAPEX ER Must try generic pramipexole.
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.
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.
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  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.
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.
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.