MDwise Medicare
Part B Step Therapy Drugs

Part B Step Therapy Drugs MDwise

Drug Name

Anticancer Agents

 

Anticancer Agents

 

ABRAXANE INTRAVENOUS SUSPENSION FOR RECONSTITUTION 100 MG

 

ADCETRIS INTRAVENOUS RECON SOLN 50 MG

 

ALIQOPA INTRAVENOUS RECON SOLN 60 MG

 

ARZERRA INTRAVENOUS 100 MG (OFATUMUMAB)

 

cyclophosphamide oral capsule 25 MG, 50 MG

 

cyclophosphamide oral tablet25 mg, 50 mg

 

CYRAMZA INTRAVENOUS SOLUTION 10 MG/ML

 

DARZALEX FASPRO SUBCUTANEOUS SOLUTION 1,800 MG-30,000 UNIT/15 ML

 

DARZALEX INTRAVENOUS SOLUTION 20 MG/ML

 

EMPLICITI INTRAVENOUS RECON SOLN 300 MG, 400 MG

 

ERBITUX INTRAVENOUS SOLUTION 100 MG/50 ML, 200 MG/100 ML

 

fulvestrant intramuscular syringe 250 mg/5 ml

(Faslodex)

GAZYVA INTRAVENOUS SOLUTION 1,000 MG/40 ML

 

HALAVEN INTRAVENOUS 1 MG  (ERIBULIN MESYLATE)

 

HERCEPTIN HYLECTA SUBCUTANEOUS SOLUTION 600 MG-10,000 UNIT/5 ML

 

HERCEPTIN INTRAVENOUS RECON SOLN 150 MG

 

ISTADOX INTRAVENOUS 10 MG (ROMIDEPSIN)

 

IXEMPRA INTRAVENOUS RECON SOLN 15 MG, 45 MG

 

KADCYLA (ADO-TRASTUZUMAB EMTANSINE)

 

KEYTRUDA INTRAVENOUS SOLUTION 25 MG/ML

 

KYPROLIS INTRAVENOUS RECON SOLN 10 MG, 30 MG, 60 MG

 

MARQIBO (VINCRISTINE SULFATE LIPOSOME)

 

OPDIVO INTRAVENOUS SOLUTION 100 MG/10 ML, 240 MG/24 ML, 40 MG/4 ML

 

RITUXAN HYCELA SUBCUTANEOUS SOLUTION 1400 MG/11.7 ML (120 MG/ML), 1600 MG/13.4 ML (120 MG/ML)

 

RITUXAN INTRAVENOUS CONCENTRATE 10 MG/ML

 

TECENTRIQ INTRAVENOUS SOLUTION 1,200 MG/20 ML (60 MG/ML), 840 MG/14 ML (60 MG/ML)

 

VELCADE INJECTION RECON SOLN 3.5 MG

 

XATMEP ORAL SOLUTION 2.5 MG/ML

 

YERVOY INTRAVENOUS SOLUTION 200 MG/40 ML (5 MG/ML), 50 MG/10 ML (5 MG/ML)

 

YONDELIS INTRAVENOUS RECON SOLN 1 MG

 

ZALTRAP INTRAVENOUS 100 MG (ZIV-AFLIBERCEPT)

 

Central Nervous System Agents

 

Central Nervous System Agents

 

RADICAVA INTRAVENOUS SOLUTION 30 MG/100 ML

 

Enzyme Replacement/Modifiers

 

Enzyme Replacement/Modifiers

 

PEGLOTICASE INTRAVENOUS SOLUTION 8 MG/ML

(Krystexxa)

Immunological Agents

 

Immunological Agents

 

AVSOLA INTRAVENOUS 100 MG (INFLIXIMAB-AXXQ)

 

CINQAIR INTRAVENOUS 100 MG (RESLIZUMAB)

 

FASENRA SUBCUTANEOUS 30 MG (BENRALIZUMAB)

 

INFLECTRA INTRAVENOUS 100 MG (INFLIXIMAB-DYYB)

 

IXIFI INTRAVENOUS 100 MG (INFLIXIMAB-QBTX)

 

PROGRAF ORAL GRANULES IN PACKET 0.2 MG, 1 MG

 

RENFLEXIS INTRAVENOUS 100 MG (INFLIXIMAB-ABDA)

 

Metabolic Bone Disease Agents

 

Metabolic Bone Disease Agents

 

DENOSUMAB SUBCUTANEOUS SYRINGE 60 MG/ML

(Prolia)

DENOSUMAB SUBCUTANEOUS SOLUTION 120 MG/1.7 ML (70 MG/ML)

(Xgeva)

DUROLANE INTRAARTICULAR 60 MG (HYALURONATE SODIUM)

 

EUFLEXXA INTRAARTICULAR 20 MG (HYALURONATE SODIUM)

 

GEL-ONE INTRAARTICULAR 30 MG (HYALURONATE SODIUM)

 

GELSYN-3 INTRAARTICULAR 16.8MG (HYALURONATE SODIUM)

 

GENVISC 850 INTRAARTICULAR 10 MG (HYALURONATE SODIUM)

 

HYALGAN INTRAARTICULAR 10 MG (HYALURONATE SODIUM)

 

HYMOVIS INTRAARTICULAR 8 MG (HYALURONATE SODIUM)

 

MONOVISC INTRAARTICULAR 88 MG (HYALURONATE SODIUM)

 

ORTHOVISC INTRAARTICULAR 30 MG (HYALURONATE SODIUM)

 

SUPARTZ INTRAARTICULAR 10 MG (HYALURONATE SODIUM)

 

SUPARTZ FX INTRAARTICULAR 10 MG (HYALURONATE SODIUM)

 

SYNVISC INTRAARTICULAR (HYALURONATE SODIUM)

 

SYNVISC-ONE INTRAARTICULAR (HYALURONATE SODIUM)

 

TRILURON INTRAARTICULAR 10 MG (HYALURONATE SODIUM)

 

TRIVISC INTRAARTICULAR 10 MG (HYALURONATE SODIUM)

 

VISCO-3 INTRAARTICULAR 10 MG (HYALURONATE SODIUM)

 

zoledronic acid intravenous recon soln 4 mg

 

zoledronic acid intravenous solution 4 mg/5 ml

 

zoledronic acid-mannitol-water intravenous piggyback 5 mg/100 ml

(Reclast)

Miscellaneous Therapeutic Agents

 

Miscellaneous Therapeutic Agents

 

CRYSVITA SUBCUTANEOUS 10 MG (BUROSUMAB-TWZA)

 

CRYSVITA SUBCUTANEOUS 20 MG (BUROSUMAB-TWZA)

 

CRYSVITA SUBCUTANEOUS 30 MG (BUROSUMAB-TWZA)

 

BOTOX INJECTION 100 UNIT (ONABOTULINUMTOXINA)

 

BOTOX INJECTION 200 UNIT (ONABOTULINUMTOXINA)

 

DYSPORT INJECTION 300 UNIT (ABOBOTULINUMTOXINA)

 

DYSPORT INJECTION 500 UNIT (ABOBOTULINUMTOXINA)

 

MYOBLOC INJECTION 2500 UNIT (RIMABOTULINUMTOXINB)

 

MYOBLOC INJECTION 5000 UNIT (RIMABOTULINUMTOXINB)

 

MYOBLOC INJECTION 10000 UNIT (RIMABOTULINUMTOXINB)

 

XEOMIN INJECTION 50 UNIT (INCOBOTULINUMTOXINA)

 

XEOMIN INJECTION 100 UNIT (INCOBOTULINUMTOXINA)

 

XEOMIN INJECTION 200 UNIT (INCOBOTULINUMTOXINA)

 

Respiratory Tract Agents

 

Respiratory Tract Agents, Other

 

NUCALA SUBCUTANEOUS AUTO-INJECTOR 100 MG/ML

 

NUCALA SUBCUTANEOUS RECON SOLN 100 MG

 

NUCALA SUBCUTANEOUS SYRINGE 100 MG/ML

 

XOLAIR SUBCUTANEOUS RECON SOLN 150 MG

 

XOLAIR SUBCUTANEOUS SYRINGE 150 MG/ML, 75 MG/0.5 ML

 

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Updated: 10/1/2021 12:29:34 PM