Traditional MedicarePrior AuthHigh impact
Step therapy drug update for Medicare – Effective January 1, 2022
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Ophthalmology, Rheumatology +2 more·Physician
Effective date
Jan 1, 2022
We identified it
Jun 19, 2026
Summary
Effective January 1, 2022, Medicare now requires step therapy documentation for multiple high-cost specialty drugs, meaning providers must document trial and failure of specific lower-cost alternatives before prescribing certain medications. Nine drugs also require new prior authorization in addition to step therapy requirements.
Action Required
Immediately: Billing team and providers must update workflows to document trial and failure of specified step therapy drugs before prescribing covered alternatives. Update EMR templates to capture required step therapy documentation for all affected HCPCS codes. Ensure prior authorization is obtained for nine newly required drugs (Monvisc, Synvisc, Hyalgan, Gelsyn, Supartz, Genvisc, Trvisc, Hymovis, Triluron). Claims will be denied without proper step therapy documentation.