Beginning January 1, 2026, Senior Health Plan (HMO) will implement step therapy requirements for certain Medicare Part B medications.

Step therapy is a process that encourages the use of clinically appropriate and cost-effective treatment options. Under this approach, your provider may need to prescribe and try one or more preferred medications before a different medication is covered by your plan.

The medications included in step therapy are selected based on clinical guidelines, safety, effectiveness, and overall value. The goal is to help ensure that members receive appropriate treatment while helping manage the rising cost of prescription drugs.

What does this mean for you?

If your medication is subject to Part B step therapy, your doctor may need to:

• Start with a preferred medication identified by the plan;
• Provide information about your previous treatment or why a preferred medication may not be appropriate; or
• Request an exception if the preferred treatment is not medically appropriate for you.

Step therapy does not mean that your doctor cannot prescribe the medication they believe is best for you. If a preferred medication is not appropriate based on your individual medical needs, your provider can request an exception or coverage determination.

We encourage you to talk with your doctor about your treatment options and whether any of your medications will be affected by the new Part B step therapy requirements.

For more information about medications subject to Part B step therapy, including applicable requirements and how your provider can request an exception, please review your plan materials or contact Customer Service at (918) 594-5323 or 1-800-642-8065. TTY/TDD users should call 1-800-722-0353.