Step therapy explained
- Some high-cost drugs are covered only after other safe more cost-effective drugs have been tried first.
- If a particular drug doesn't provide the required therapeutic benefit, MedicareBlue Rx may cover an alternative drug upon request.
- You may appeal the step therapy requirement by encouraging your prescribing physician to request an exception using the form below. Review the step therapy criteria list for alternative treatments.
MedicareBlue Rx will be accepting Coverage Determination requests for 2019 beginning November 1, 2018.
Request an exception to the plan step therapy requirement with the step therapy exception fax form
Step therapy guidelines
- The prescribing physician can fax the applicable step therapy form to MedicareBlue Rx for any drug that appears on the step therapy list.
- Once a 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 pharmacist or physician).
- Have questions? Contact us at:
Search the drug list (formulary) to find out if your drug requires step therapy or prior authorization.