Medical Step Therapy Updates for Healthy Blue + MedicareSM (HMO D-SNP)

Please note, this communication applies to Healthy Blue + Medicare℠ (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina.

Effective March 1, 2022, FDA-approved biosimilar agents to Avastin, Mvasi, and Zirabev will not be included in the preferred product step.

Step therapy review will apply upon precertification initiation, in addition to the current medical necessity review, as is current procedure. Step therapy will not apply for members who are actively receiving the nonpreferred medications listed below.

Clinical Criteria are publicly available on the provider website. Visit the Clinical Criteria page to search for specific criteria.

Clinical Criteria: INC-CC-0072 

Preferred Drug(s) 

• Avastin
• Eylea

Nonpreferred Drug(s)

• Lucentis
• Macugen
• Beovu

For more information, go to the Healthy Blue Medicare page.

BNCCARE-0256-22 January 2022