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The Step Therapy Program ensures that your medication use is safe and cost-effective. Under this program, a "step" approach is required to get coverage for certain high-cost medications. To get coverage you may need to first try a proven, cost-effective medication (first-line drug) before using a more costly medication (second-line drug).
How the program works
If your doctor prescribes you a drug that is part of the Step Therapy program, he or she will need to write you a prescription for a first-line drug or submit a prior authorization request form to get approval from Blue Cross and Blue Shield.
Drug categories may be added and the medications listed are only examples. To make sure you have the most recent list available, call 1-877-217-7986 with questions about a specific medication.
Your doctor can find the forms on the Prime Therapeutics website. Doctors may visit the website or call 1-800-285-9426 for more information.
Because step therapy programs can differ between health insurance carriers, it's important to check to see if any medications you’re taking now are part of the BCBS Step Therapy program.
If it is on the list, your doctor will need to submit a prior authorization request form to get approval once you become a BCBS member, before the medicine can be covered.