Step therapy explained

Step therapy is like a guided path to finding the most effective medication by starting with treatments that are evidence-based, well-established, safe, affordable, and have fewer side effects before progressing to more costly alternatives.

If the first medication doesn’t work for you, your doctor can help move you to the next step ensuring you get what’s best for your unique needs.

Your doctor prescribes a medication and you find out that it requires step therapy at the pharmacy, either you or your pharmacist should tell your doctor. It’s possible there’s a different drug they could prescribe that doesn’t require step therapy.

If that is not an option, then your doctor can work with you through the step therapy process. If the generic or other alternatives work well for you, that is good news because you will most likely pay less out of pocket for the medicine. If this is not an option, your doctor can submit a request to your Blue Cross health plan for an exception, which is called a “coverage determination." If approved, the requested medication would be covered ongoing.