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.
- Step Therapy Exception Fax Form
- Request an exception to the plan step therapy requirement
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 Customer Service for Blue MedicareRx:
- Toll Free 1-877-853-7693
- TTY hearing impaired users call 711
- 8 am to 8 pm, daily, local time
Search the drug list (formulary) to find out if your drug requires step therapy or prior authorization.