For certain Medicare Part B drugs, Alignment Health Plan may require you to first try preferred drugs to treat your medical condition before we will cover non-preferred drugs for the same 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 Part B drugs you have not taken in the last 365 days. If you received the requested non-preferred drug within the past 365 days, you will not be required to change to a preferred drug.

Unless otherwise specified in the applicable coverage policy, non-preferred Part B drugs within a therapeutic class listed below, including newly approved or newly marketed products, may be subject to step therapy through the preferred product(s). This list is a summary and does not replace the applicable coverage policy or your Evidence of Coverage. This list may be updated during the year in accordance with applicable regulatory and notice requirements. You and your provider should review the current coverage policy before a drug is administered.

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