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, Blue MedicareRx 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.
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 Blue MedicareRx 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:
Use the coverage and pricing tool to find out if your prescription drug has a prior authorization requirement.