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Part B drugs and supplies

Part B of Original Medicare covers Medicare Part B drugs. Mercy Care Advantage members can get coverage for these drugs when medically necessary.


Part B drug step therapy

The Centers for Medicare & Medicaid Services (CMS) lets Medicare Advantage plans implement step therapy requirements for Part B drugs. We have done so and use the 2024 CVS Caremark® Advanced Biosimilars - First Medical Preferred Drug List - Medicare Part B Step Therapy (PDF).


You can submit PA for:

  • Medicare Part B drugs that are medically necessary

  • Non-preferred Medicare Part B drugs instead of preferred Part B drugs: usually applies when people are already in an active course of treatment

Just provide one of these:

  • A supporting statement reflecting trial and failure of the preferred drug

  • A medical reason the member can’t take the preferred drug

  • A medical reason the preferred drug wouldn’t be as effective as the requested non-preferred drug


How to submit PA

Fax our Medical Prior Authorization Department at 1-800-217-9345. We’ll review:

  • Standard requests within 72 hours

  • Expedited requests within 24 hours

Glucose meters and supplies

  • FreeStyle Libre® and Dexcom® are the preferred brands of continuous glucose meters and supplies.

  • OneTouch® is the preferred brand of glucose meters and test strips.

  • Non-preferred diabetes supplies need PA.

Learn more about Part B

Read about Part B drugs in Chapter 4, Benefits Chart in the Mercy Care Advantage Evidence of Coverage 2024 English | 2024 Espanol (PDF).


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