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Provider Manual

Step Therapy

Last Updated on January 24, 2019

Step therapy is a pharmaceutical utilization management tool that requires using one or more drugs in a step-wise approach. Step therapy programs typically promote the use of generics or other cost-effective alternatives as the first choice drug before progressing to more costly alternatives. Step therapy is in place of a traditional prior authorization process when a trial with a preferred first-line drug is the only prerequisite for coverage.

In cases when the member requires the step therapy drug as a first-line option, supporting documentation is requested from the provider. Exceptions will be considered if first-line drugs are inappropriate, for example, due to a valid medical contraindication. To request an exception, refer to the Pharmacy Authorization Requests section.

Family Health Center’s step therapy programs are indicated on the Formulary Guide available online here.