Step Therapy

To receive prescription drug benefits for certain drugs, the Plan requires you to first try less-expensive drugs that have been shown to be clinically effective for your condition. This is referred to as “step therapy.” If the less-expensive drug(s) is not effective for you, the Plan will then provide coverage for a more-expensive option. The Coverage Tiers (Formulary) identifies drugs that require step therapy (ST).

Your doctor, nurse practitioner (NP), or pharmacist can provide information about your step-therapy options. Generally, your pharmacist can obtain a revised prescription from your doctor or NP by telephone or fax, with no need for you to make an additional office visit.