Updated Medicare Part B step therapy prior authorization requirements

Effective for dates of service starting Jan. 1, 2026, we will require prior authorization for medications included in the UnitedHealthcare® Medicare Advantage Part B step therapy program. You’ll find the latest information, including excluded plans, in the Medicare Part B Step Therapy Programs Policy. 

View the list of medications included in the Part B step therapy program. Please note that preferred products in the following categories will require prior authorization beginning Jan. 1, 2026:

Step therapy requirements

You may need to seek prior authorization for members new to our plans without a UnitedHealthcare claims history.

Members already treated with a non-preferred drug/product in the Part B step therapy program (existing utilizers) are exempt from step therapy requirements. For the purposes of this program, an existing utilizer means the member has a paid claim for the drug/product within the past 365 days or has clinical documentation of current use of the non-preferred drug/product.

Step therapy prior authorization process 

The step therapy prior authorization process evaluates whether the drug is appropriate for the individual member, taking into account:

• Applicable Medicare coverage determination guidance
• Dosage recommendation from the FDA-approved labeling
• Terms of the member’s benefit plan
• Trial and failure of preferred products
• The member’s treatment history

How to submit and manage prior authorizations

• Sign in to the UnitedHealthcare Provider Portal with your One Healthcare ID 
  • If you don’t have a One Healthcare ID, register now 
• From the left-hand tabs, select Prior Authorizations & Notifications

For training, view our Prior Authorization and Notification interactive guide.

Determination and review timeline

We will complete prior authorizations, or preservice coverage determinations, for Part B drugs within 72 hours for standard requests or 24 hours for expedited requests. Notifications of the case determination, including appeal rights when applicable, will be provided within the required time frame.

If sufficient clinical information is not received, a denial decision will be issued. To prevent denials due to a lack of information, please submit all clinical information when you submit a Part B drug prior authorization request.

Eligible members

Step therapy requirements apply to UnitedHealthcare Medicare Advantage plans, including UnitedHealthcare Dual Complete®, Peoples Health and Preferred Care Partners plans of Florida. Specific Plan exclusions are noted in the Medicare Part B Step Therapy Programs Policy.

Prior authorization requests for Part B drugs included in the step therapy program should follow standard medical authorization practices, including within plans that have delegated utilization management operations to medical groups and/or independent practice associations (IPAs). Please submit authorization requests according to the plan protocols.