New preferred products for Medicare Part B drugs start Oct. 14

Starting Oct. 14, we’ll have preferred products for two classes of Medicare Part B medications: Hyaluronic Acid (HA) Derivatives and Erythropoietin Stimulating Agents (ESA).

We will require patients who have a new prescription to use the preferred products for the Medicare Part B drugs below. Members who are already using the non-preferred products may be changed to preferred products, but this will not be required.

Non-preferred products Preferred products
Drug class: Hyaluronic acid derivatives
  • Gel-One
  • GelVisc 850
  • Hyalgan
  • Hymovis
  • Monovisc
  • Orthovisc
  • Synvisc/Synvisc One
  • Triluron
  • Trivisc
  • Visco 3

All require step therapy with:

  • Efluxxa and either
  • Durolane, Gelsyn-3, Supartz or Supartz FX
Drug class: Erythropoietin stimulating agents

Epogen

Requires step therapy with:

  • Procrit and
  • Retacrit

If you believe the preferred products aren’t appropriate for one of your patients, you must ask for an exception to the step therapy requirement, by providing clinically supportive rationale for the use of the non-preferred product over the preferred product.