Plan Options

• MedicareBlue PPO (Regional PPO)
• MedicareBlue Rx (PDP)
• Medicare Supplement Plans & Other Options
• Group Plans

MedicareBlue Rx (PDP)

Step Therapy

In step therapy, certain high-cost drugs are covered by MedicareBlue Rx (PDP) only after other safe, clinically appropriate, and more cost-effective drugs have been tried. If step-one drugs do not provide the required therapeutic benefit, MedicareBlue Rx (PDP) will cover a step-two drug.

In the event you need a prior authorization to override the step therapy requirement, we encourage your prescribing physician to use the appropriate physician request for step therapy authorization and fax it to the number provided on the form for all medications where the initial step therapy criteria was not met.

Following are the step therapy program guidelines:

• The prescribing physician can fax the applicable step therapy form to MedicareBlue Rx (PDP) for any drug that appears on the step therapy list;
• Contact Customer Service for MedicareBlue Rx (PDP):

Toll Free 1-888-832-0075
TTY users call 1-800-693-3819
8 a.m. to 8 p.m., daily, Central and Mountain Time

Once the drug is authorized, it can be filled at any participating pharmacy (except for the few drugs which may require a specialty pharmacy; check with your physician).

Search the drug formulary to find out if your drug requires prior authorization.