1. What is Step Therapy?
2. How are the drugs chosen for Step Therapy?
3. What are the first-line and second-line drugs, and what conditions are treated under Step Therapy?
4. Why couldn't I fill my prescription at the pharmacy?
5. How do I know what "first-step" drug my doctor should prescribe?
6. I need a prescription filled immediately. What can I do?
7. I've already tried the first-step drugs on the list. What happens now?

Step Therapy is a program especially designed for people who take prescription drugs regularly to treat an ongoing medical condition. The program helps you get the prescription drugs you need, with safety, cost and—most importantly—your health in mind.

In Step Therapy, the covered drugs you take are organized in a series of “steps,” with your doctor approving and writing your prescriptions.

• The program usually starts with generic drugs in the “first step.” These generics—rigorously tested and approved by the U.S. Food & Drug Administration (FDA)—allow you to begin or continue treatment with safe, effective drugs that are also affordable: Your copayment is usually the lowest with a first-step drug.
• More expensive brand-name drugs are usually covered in the “second step,” even though the generics covered have been proven to be effective in treating medical conditions.

Your doctor is consulted for approval and writes your prescriptions based on the list of Step Therapy drugs covered by the formulary.

Step Therapy is developed under the guidance and direction of independent, licensed doctors, pharmacists and other medical experts. Together with Express Scripts they review the most current research on thousands of drugs tested and approved by the Food and Drug Administration for safety and effectiveness. Then they recommend appropriate prescription drugs for the Step Therapy program, and Concordia Plan Services approves the drugs that will be covered.

What are the first-line and second line drugs, and what conditions are treated under Step Therapy?

Click here for a complete list of all the conditions treated by Step Therapy and for a list of all the medications included in the program.

The first time you submit a prescription that isn’t for a first-step drug, your pharmacist will tell you there’s a note on the computer system indicating that our plan uses Step Therapy. This simply means that if you’d rather not pay full price for your prescription drug, your doctor needs to write you a new prescription for a first-step drug.

To receive a first-step drug:

• Ask your pharmacist to call your doctor and request a new prescription.
  OR
• Contact your doctor to get a new prescription.

Only your doctor can change your current prescription to a first-step drug. .

You can call Express Scripts using the number on the back of your prescription card. A representative can give you some examples of possible prescription drugs for you to discuss with your doctor.

At the pharmacy, you may be informed that your drug isn’t covered if you’ve just started taking a prescription drug regularly or if you’re a new member. If this occurs and you need your medication right away, you can:

• Talk with your pharmacist about filling a small supply of your prescription. You may have to pay full price for this drug.
• Then, ask your doctor to write you a new prescription for an approved first-step drug, so that your medication will be covered.
  

Remember: Only your doctor can approve and change your prescription to a first-step drug.

I've already tried the first-step drugs on the list. What happens now?

With Step Therapy, more expensive brand-name drugs are usually covered in a later step in the program if:

• you’ve already tried the “first-step,” generic drugs covered in the program
• you can’t take the “first-step” drug (because of an allergy, for instance)
• your doctor decides you need a brand-name drug, for medical reasons
  

If any one of these applies to you, your doctor can ask for a “prior authorization” for you to take a second-step prescription drug. Once the prior authorization is approved, you pay the appropriate copayment for this formulary-approved drug. If the prior authorization is not approved, you will need to pay the full price for the drug.