What is Step Therapy?

• Step Therapy is the practice of beginning drug therapy for a medical condition with the most cost-effective and safest drug therapy and moving to other more costly therapy, if necessary.
• This program is a series of steps involving your doctor. It is only for people who take prescription drugs to treat certain ongoing medical conditions.

The Step Therapy Process

First Step:

• Uses primarily generic drugs.
• Lowest copayment applies.

First step drugs must be used before the plan pays for second step drugs.

Second Step:

• Uses primarily brand name drugs.
• Higher copayment normally applies.

The program moves you to this step if your treatment plan requires a different medication.

Prescriptions for a second step drug processed at your pharmacy for the first time triggers a message to your pharmacist indicating the use of Step Therapy. You pay full price for the prescription drug unless your doctor prescribes a first step drug. Only your doctor can change the prescription.

If your doctor decides, for medical reasons, your treatment plan requires a different medication without trying a first step drug, he/she must request a prior authorization from ESI. You could pay a higher copayment than for a first step drug, and if it cannot be covered, you pay full price.

If you have an active prescription (filled within the last 130 days) for a second step medication, it is not affected by this program.