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 ST
Abilfy Seroquel ST
ADDERALL (dextroamphetamine/amphetamine)
ADDERALL XR (dextroamphetamine/amphetamine)
ADOXA (doxycycline monohydrate)
Amrix and Fexmid ST
Anora Ellipta ST
APTENSIO XR (methylphenidate)
Atypical Antipsychotics ST and QL
Atypical Antipsychotics for Major Depressive Disorder ST
Arava ST
Aricept ST
Aromatase Inhibitors ST
Avandia Products ST
BELBUCA (buprenorphine)
Caverject_Edex ST
CELEBREX (celecoxib)
CLARINEX (desloratadine)
CLARINEX-D (desloratadine/pse levocetirizine)
CONCERTA (methylphenidate hcl)
Conzip ST and QL
Crestor ST
Daliresp ST
DESOXYN (methamphetamine hcl)
DEXEDRINE (dextroamphetamine sulfate)
Dificid ST
DORYX (doxycycline hyclate)
FARXIGA (dapagliflozin propanediol)
Fetzima ST
FOCALIN (dexmethylphenidate hcl)
FOCALIN XR (dexmethylphenidate hcl er)
Forfivo XL ST
GLP-1 Analogs ST
GLYXAMBi (empagliflozin/linagliptin)
Gralise ST
Hep B Agents ST
Horizant ST
Hypnotics ST
INCRUSE ELLIPTA (umeclidinium)
INVOKAMET (canagliflozin/metformin hcl)
INVOKANA (canagliflozin)
Inspra ST
JARDIANCE (empagliflozin)
Liptruzet ST
METADATA CD (methylphenidate hcl)
METADATE ER (methylphenidate hcl)
METHYLIN (methylphenidate hcl)
MONODOX MONDOXYNE NL (doxycycline monohydrate)
Nasal Steriods ST
Neupro ST and QL
ORACEA (doxycycline monohydrate)
Oral Proton Pump Inhibitors ST
Osteoporosis ST
Otezla ST
Potiga PA and ST
Pristiq ST and QL
PROCENTRA (dextroamphetamine sulfate)
Qudexy XR ST
QUILLIVANT XR (methylphenidate hcl)
RASUVO (methotrexate)
Rescula ST
Rexulti ST and QL
RITALIN (methylphenidate hcl)
RITALIN LA (methylphenidate hcl)
RITALIN SR (methylphenidate hcl)
SEEBRI NEOHALER (glycoprrolate)
Simcor ST
Singulair ST
SOLODYN (minocycline hcl)
STRATTERA (atomoxetine hcl)
SYNJARDY (empagliflozin/metformin hcl)
Tekturna ST
Treximet ST
Triptan Agents ST
TUDORZA PRESSAIR (aclidinium bromide)
Uloric ST and QL
UTIBRON NEOHALER (indacaterol/glycopyrrolate)
VIBERZI (eluxadoline)
Vimovo ST and QL
Vytoria-Zetia ST
XIGDUO XR (dapagliflozin/metformin hcl)
Xopenex ST
XYZAL (levocetirizine)
Zipsor ST and QL 

Last Updated: 01/22/2016