Under Kaiser Permanente Medicare Advantage (HMO) health plans, some injectable Part B drugs administered by your provider may have special coverage requirements or limits.
What is step therapy?
One of these special coverage requirements or limits is known as step therapy. This means that Kaiser Permanente requires you to first try a preferred Part B drug to treat your medical condition before covering a non-preferred drug for that same condition. The preferred drug is equally effective but usually less costly for you.
Here's how it works
If preferred Drug A and non-preferred Drug B both treat your medical condition, Kaiser Permanente may require that you try Drug A first. If Drug A does not work, then Drug B will be covered by your plan. The preferred drugs are listed in the link below and should be tried first.
- Certain medical conditions may be excluded from the step therapy requirement.
- The step therapy requirement does not apply if you have received treatment with the non-preferred drug within the past 365 days. For example, if you are a new or existing member and have been using a non-preferred drug within the past 365 days, you will not be required to switch to the preferred drug when you enroll in a Kaiser Permanente Medicare Advantage plan. Similarly, an existing member using a non-preferred drug will not be required to change drugs.
Learn about Medicare health plans for group, state, and federal employees
If you are becoming eligible for Medicare and your employer offers a group retiree Medicare Advantage health plan through Kaiser Permanente Washington, call us at 1-800-581-8252 or TTY 711 from 8 a.m. to 5 p.m. Monday through Friday.
FEHB and PEBB members can also find information online:
- FEHB (Federal Employees Health Benefits) Program health plans
- PEBB (Public Employees Benefits Board) Program health plans
Key Medicare health plan enrollment dates
Medicare Annual Enrollment Period (AEP)
October 15 through December 7
Medicare Initial Coverage Election Period (ICEP)
65th birthday month + 3 months before and after
Medicare Advantage Open Enrollment Period (MA OEP)
January 1 through March 31
Medicare Star Quality Ratings
Our Medicare Advantage health plan was rated 4.5 out of 5 Stars in Washington for 2021. The Medicare Star Rating is based on quality, service, and member satisfaction. Our high rating means you can have peace of mind knowing that you're getting high-quality care and coverage — all in a single plan at a great value.1
NCQA Quality Rating
Kaiser Permanente Washington Medicare Advantage (HMO) plan was rated 4.5 out of 5 in the National Committee for Quality Assurance (NCQA) Medicare Health Insurance Plan Ratings 2019-2020.2