What is Step Therapy?

A FlexScripts Fact Sheet

Step Therapy is a program that starts the drug therapy for a medical condition with the best, safest, and most economical medication. If needed, the therapy moves on to more costly, riskier medication. The goals of a Step Therapy program are to both keep costs under control, and to minimize the risk to you. Step Therapy programs can include medications for:

  • Cholesterol lowering
  • Allergies
  • Depression
  • Inflammation such as arthritis

The program makes generic prescription drugs available as a first step before switching to branded prescription drugs. The generic prescription drugs are provided for you with safety, cost and—most importantly—your health, in mind. Step Therapy programs also help your employer control the rising cost of medication.

How Does it Work?

  • The program usually starts with generic drugs in the “first step”. This first step allows you to begin or continue treatment with safe, effective prescription drugs that are also affordable: Your copayment is usually the lowest with a first step drug.
  • Brand-name drugs are usually covered in the “second step”. Your copayment will be higher than with a first-step drug.
  • Step Therapy is developed under the guidance and direction of FlexScripts Administrators and licensed pharmacists and doctors.

Frequently Asked Questions

What does step therapy mean to me?

Step Therapy is an opportunity for you to save out of pocket money when you get a prescription.

What happens if I am already established on a drug in second or third category? Will I have to start all over again?

No. However, you will need validation of utilization to get your medication. This change only applies to members who are starting on these medications.

How does the Prior Authorization process work?

Your physician’s office or your pharmacist should contact FlexScripts Administrators to request a Prior Authorization form to be faxed to the physician’s attention.