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 Guidelines:
ARB and ARB Combo
Abilfy Seroquel
ADOXA (doxycycline monohydrate)
Anora Ellipta ST
Atypical Antipsychotics ST and QL
Atypical Antipsychotics for Major Depressive Disorder ST
ARAVA (leflunomide) 
Aromatase Inhibitors
ASTAGRAF XL (tacrolimus)
Avandia Products
BELBUCA (buprenorphine)
Brintellix (vortioxetine)
CAVERJECT EDEX (alprostadil)
CELEBREX (celecoxib)
CLARINEX (desloratadine)
CLARINEX-D (desloratadine/pse levocetirizine)CONCERTA (methylphenidate hcl)
Conzip ST and QL
Crestor ST 
DALIRESP (roflumilast)
DPP4 Inhibitors
DESOXYN (methamphetamine hcl)
Desvenlafaxine
Diclofenac
DIFICID (fidaxomicin)
DORYX (doxycycline hyclate)
FARXIGA (dapagliflozin propanediol)
FETZIMA (levomilnacipran)
Forfivo XL ST
GLP-1 Analogs ST
Glaucoma
GLYXAMBi (empagliflozin/linagliptin)
Gralise ST
Hep B Agents
Horizant ST
Hypnotics
INCRUSE ELLIPTA (umeclidinium)
INVOKAMET (canagliflozin/metformin hcl)
INVOKANA (canagliflozin)
INSPRA (eplerenone)
JARDIANCE (empagliflozin)
Liptruzet ST
Luzu (luliconazole)
Nasal Steriods
Neupro ST and QL
ORACEA (doxycycline monohydrate)
Oral Proton Pump Inhibitors
Potiga PA and ST
Pristiq ST and QL
Qudexy XR ST
RASUVO (methotrexate SQ)
Rexulti ST and QL
SEEBRI NEOHALER (glycoprrolate)
Sernivo (betametasone)
Simcor
SOLODYN (minocycline hcl)
SYNJARDY (empagliflozin/metformin hcl)
TREXIMET (naproxen-sumatriptan)
Triptan Agents
TUDORZA PRESSAIR (aclidinium bromide)
Uloric ST and QL
UTIBRON NEOHALER (indacaterol/glycopyrrolate)
VIBERZI (eluxadoline)
VIMOVO (naproxen-esomeprazole)
VYTORIN
XIGDUO XR (dapagliflozin/metformin hcl)
XOPENEX (levalbuterol)
XYZAL (levocetirizine)
ZIPSOR (diclofenac)

Last Updated: 06/04/2016