Step Therapy Guidelines

Step therapy is in place for the drugs listed below. Step Therapy is the practice of beginning drug therapy for a medical condition with the most cost-effective and safest drug and progressing to other more costly or risky therapy, only if necessary (i.e., you must try drug "A" before you can get drug "B"). The goal is to control costs and minimize risks. Step therapy is an automated process. If a prescription is presented for a "step therapy" drug (i.e., "B") to a pharmacy, an automated check of the member's prescription history will occur. If the system finds that the member has received the qualifying drug(s) (i.e., "A"), the prescription will be processed. If the system does not find the qualifying drug (i.e., "A") in the member's recent history, a prior authorization will be necessary. The step therapy guidelines are developed and reviewed by a panel of practicing physicians and pharmacists.


Click on the drug name below to view the specific step therapy guidelines 

Commercial & Medicare Guidelines:
Atypical Antipsychotics ST
Arava ST
Caverject_Edex ST
Celebrex ST
Clarinex_Allegra_Xyzal ST
Fetzima ST
Dificid ST
Forfivo ST
GLP-1 Agonists ST
Hep B Agents ST
Hypnotics ST
Inspra ST
Myrbetriq ST
Nasal Steriods ST
Non-Sedating Antihistamines ST
Potiga ST
Pristiq ST
Ryzolt ST
Simcor ST
Singulair ST
Tekturna ST
Treximet ST
Uloric ST
Vimovo ST_QL
Xopenex ST
Zetia_Vytorin ST

Commercial-Only Guidelines:
ARB and ARB Combo ST (Commercial Only)
Abilfy Seroquel ST Criteria (Commercial Only)
Amrix and Fexmid ST (Commercial Only)
Aricept ST (Commercial Only)
Aromatase Inhibitors ST (Commercial Only)
Avandia Products ST (Commercial Only)
Daliresp ST (Commercial Only)
Glaucoma_ST (Commercial Only)
Horizant ST (Commercial Only)
Oral Proton Pump Inhibitors ST (Commercial Only)
Osteoporosis ST Criteria (Commercial Only)
Triptan Agents ST Criteria (Commercial Only)
Zipsor ST and QL Criteria (Commercial Only)

Medicare-Only Guidelines:
ARB and ARB Combo ST (Medicare Only)
Invokana ST (Medicare Only)
Toviaz ST
Triptan Agents ST (Medicare Only)