Step therapy is a key part of our prior authorization program that allows us to help your doctor provide you with an appropriate and affordable medication treatment. Before filling a prescription for certain costly "second-step" medications, we require that you first try an effective, but less expensive "first-step" medication.
For example, if you're diagnosed with hypertension, you may be required to initially try an effective and affordable first-step therapy like lisinopril before trying more expensive second-step therapies such as Avapro®'' and Diovan®''.
Please note that:
- If you've already tried a first-step medication and your doctor prescribes a second-step treatment, coverage for that second-step alternative is automatically approved in most cases.
- If your prescription records do not indicate the use of a first-step medication, or if you are a newly enrolled member with no prescription history, your physician may contact us directly to request an exception to the step therapy program.
For a complete listing of step therapy medications, please refer to your Formulary Guide.