Medicare AdvantagePrior AuthMedium impact
Medicare Part B Step Therapy Product Updates
Florida Blue·FL · Oncology, Hematology, Ophthalmology +1 more·Medicare
Effective date
Jul 15, 2025
We identified it
Jun 16, 2026
Summary
Florida Blue Medicare updated its Part B Step Therapy program effective July 15, 2025, removing Erythropoiesis Stimulating Agents from step therapy requirements and adding new non-preferred drugs in Cancer/Supportive Therapy, Complement Inhibitors, and Ophthalmic Agents categories that will require step therapy through preferred alternatives first.
Action Required
By July 15, 2025: Billing team must update prior authorization requirements for newly added non-preferred drugs including Sustol (J1627), Posfrea (J2468), Focinvez (J1434), Cinvanti (J0185), and Izervay (J2782). Remove step therapy requirements for Erythropoiesis Stimulating Agents (Procrit/Epogen, Aranesp, Mircera). Update billing system to reflect new preferred alternatives and ensure providers are aware of step therapy requirements for non-preferred products.