Step
Therapy |
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Step
Therapy is a program especially designed for people who
take prescription drugs regularly to treat an ongoing medical
condition. The program helps to provide the medication you
need from among the thousands available so that you are
getting the safest, most effective treatment while keeping
your costs as low as possible. |
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| Step
Therapy moves you along a clear, well-planned path, with your
doctor approving your medications every step along the way.
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| In the
first step of treating your condition, your physician writes
a prescription for what are called “first-line”
medications. If the first-line medication does not provide
the therapy required, then your physician takes the second
step by prescribing second-line medications which are usually
brand-name drugs covered under the Express Scripts formulary.
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Since
a variety of drugs exist with the same therapeutic benefit,
Express Scripts works with your pharmacy to make the Step
Therapy program run as efficiently as possible. |
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Here’s
how it works:
- When
a prescription for a second-line drug is being processed
at the pharmacy, the online computer system will scan
your recent prescription record.
- If
the system finds a record that you have tried a first-line
alternative, the second-line will be dispensed as written.
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If, however, the system doesn't find a record of first-line
alternative usage, the pharmacist will be alerted that
the prescription is not a covered benefit, and first-line
alternatives will be recommended. Your physician will
then be notified to approve any change to the prescription.
(The process is similar with mail order prescriptions.)
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You can always choose to sidestep the first-line medications
and go directly to the second-line, brand-name drug, but
the formulary brand copays will not apply, and you will
be responsible for 100% of the cost of the brand-name
drug.
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| Click
here for Step Therapy Frequently
Asked Questions. |
| Click
here for Step Therapy
Programs and First-line/Second line Medications. |
