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Step Therapy Program

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

  • Step 1: When possible your doctor should prescribe a first line medication appropriate for your condition.
  • Step 2: If your doctor decides that a first line drug is not right for you or is not effective in treating your condition, your prescription drug benefit plan will cover a second line drug when certain criteria are met.

Drug Categories

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.

  • If the request is approved, you will pay for your share of the drug, based on your prescription drug benefit plan.
  • If the request is not approved, you can still fill your prescription but you may have to pay the full amount charged, based on your benefit plan.

Step Therapy Program Drugs and Categories

Drug categories may be added and the medications listed are only examples. To make sure you have the most recent list available, call 1-877-325-2996 with questions about a specific medication.

Your doctor can find the forms on the Prime Therapeutics website. Doctors may visit the website or call 1-800-289-1525 for more information.

New to Blue Cross and Blue Shield?

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.