Part B Prescription Drugs -
Subject to Step Therapy
In some cases, Alignment Health Plan may require you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. This is called step therapy, which is a managed care approach to taking prescription drugs. For example, if Drug A and Drug B both treat your medical condition, Alignment Health Plan may not cover Drug B unless you try Drug A first. If Drug A does not work for you, Alignment Health Plan will then cover Drug B.
Step therapy only applies to new prescriptions or medications you have not taken in the last 365 days. This step therapy requirement will not apply to patients who are actively receiving treatment with a nonpreferred drug (i.e., have a paid drug claim within the past 365 days).
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Medications Subject to Step Therapy*
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Preferred Medications
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For neovascular (wet) age-related macular degeneration (AMD):
Beovu (brolucizumab-dbll)
Byooviz (ranibizumab-nuna)
Cimerli (ranibuzumab-eqrn)
Eylea (aflibercept)
Lucentis (ranibizumab)
Susvimo (ranibizumab)
Vabysmo (faricimab-svoa)
For macular edema following retinal vein occlusion (RVO):
Byooviz (ranibizumab-nuna)
Cimerli (ranibuzumab-eqrn)
Eylea (aflibercept)
Lucentis (ranibizumab)
Vabysmo (faricimab-svoa)
For diabetic macular edema (DME):
Cimerli (ranibuzumab-eqrn)
Eylea (aflibercept)
Lucentis (ranibizumab)
For diabetic retinopathy:
Cimerli (ranibuzumab-eqrn)
Eylea (aflibercept)
Lucentis (ranibizumab)
For myopic choroidal neovascularization (mCNV):
Byooviz (ranibizumab-nuna)
Cimerli (ranibuzumab-eqrn)
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Avastin (bevacizumab)
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Rituxan (rituximab)
Rituxan Hycela (rituximab and hyaluronidase human)
Truxima (rituximab-abbs)
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Riabni (rituximab-arrx)
Ruxience (rituximab-pvvr)
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Prolia (denosumab)
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zoledronic acid
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* Step therapy prescription drug list is subject to change at any time