Step Therapy

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.

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 Customer Service for MedicareBlue Rx:
    • Toll Free 1-888-832-0075
    • TTY hearing impaired users call 711
    • 8 am to 8 pm, daily, Central and Mountain Times

Search the drug list (formulary) to find out if your drug requires step therapy or prior authorization.