Step Therapy - Woodgrain
Transcript of Step Therapy - Woodgrain
Step Therapy
Most medical conditions have multiple medication options. Although their clinical effectiveness may be similar, prices can vary widely. With the Step Therapy program, you get the treatment you need, usually at a lower cost.
Here’s how it works:
With this program, you need to try a Step 1 medication first, before a Step 2 medication may be covered. When you bring a prescription to the pharmacy, our system will automatically screen the medication for step therapy requirements. If your prior pharmacy claims show you have tried a Step 1 medication in the recent past, the Step 2 medication may be processed. If not, the pharmacist will contact your doctor for further explanation.
There are some drugs that require three steps before a medication is covered. You must try Step 1 and Step 2 medications before receiving benefit coverage for a Step 3 medication.
We encourage you to discuss your treatment and medication options with your doctor. If you have questions about the Step Therapy program, call the toll-free member phone number on the back of your ID card.
You get a prescription
Try a Step 1 medication first
Before a Step 2 medication is covered
Step Therapy Program
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Step Therapy Medications (2 steps)*
If you have a prescription for any of the following Step 2 medications, you will be required to first try a Step 1 medication(s) for benefit coverage.
Condition Step 1 Step 2
Attention Deficit Disorder
Any two of the following: Dextroamphetamine, Amphetamine-dextroamphetamine, Methylphenidate, Dexmethylphenidate, Vyvanse
Procentra/Dextroamphetamine, Desoxyn/Methamphetamine, Adderall XR/Amphetamine ER, Kapvay/Clonidine ER, Focalin XR/Dexmethylphenidate ER, Metadate CD/Methylphenidate ER, Ritalin SR/Concerta/Methylphenidate ER, Methylin/Methylphenidate Solution, Ritalin LA/Methylphenidate ER, Daytrana, Methylin, Quillivant
Antibiotics Doxycycline Acticlate, Adoxa, Doryx
Bethkis Tobi Neb/Tobramycin Neb
Antipsychotics Any two of the following: Olanzapine, Risperidone, Risperidone ODT, Quetiapine, Seroquel XR, Saphris, Abilify
Geodon/Ziprasidone, Fanapt, Invega, Latuda
Asthma/COPD Any one of the following: Symbicort, Advair Diskus, Foradil, Serevent
Striverdi
Any one of the following: Advair Diskus, Advair HFA, Symbicort
Dulera
Any one of the following: Symbicort, Advair Diskus, Foradil, Serevent, Spiriva, Breo Ellipta
Anoro Ellipta
Montelukast and any one of the following: Methylprednisolone, Prednisolone, Prednisone, Ventolin HFA,Proair HFA, Foradil, Serevent, Qvar, Pulmicort, Flovent Diskus, Flovent HFA, Asmanex, Advair Diskus, Advair HFA, Symbicort
Zyflo, Zyflo CR
Bold type = Brand-name drug Plain type = Generic drug
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Condition Step 1 Step 2
Cardiovascular Carvedilol Coreg CR
Any one of the following: Benazepril, Candesartan, Captopril, Enalopril, Fosinopril, Irbesartan, Lisinopril, Moexipril, Perindopril, Quinapril, Ramipril, Telmisartan, Trandolapril, Benazepril-amlodipine, Trandolapril-verapamil, Benazepril-HCTZ, Captopril-HCTZ, Enalapril-HCTZ, Fosinopril-HCTZ, Irbesartan-HCTZ, Lisinopril-HCTZ, Moexipril-HCTZ, Quinapril-HCTZ, Losartan, Losartan-HCTZ
Edarbi, Edarbyclor, Azor, Exforge, Exforge HCT, Tribenzor
Amlodipine and any one of the following: Atorvastatin, Lovastatin, Pravastatin, Simvastatin, Crestor, Vytorin
Caduet/Amlodipine-atorvastatin
Cholesterol Lowering Agents
Lipofen and any one of the following: Fenofibric Acid, Fenofibrate
Fibricor, Fenoglide, Triglide
Any one of the following: Atorvastatin, Lovastatin, Pravastatin, Simvastatin, Crestor
Lipitor, Lescol/Fluvastatin, Lescol XL, Mevacor, Altroprev, Livalo, Pravachol, Zocor
Any one of the following: Atorvastatin, Lovastatin, Pravastatin, Simvastatin, Crestor, Vytorin
Liptruzet
Depression Any two of the following: Citalopram, Escitalopram, Fluoxetine, Paroxetine, Paroxetine ER, Sertraline, Venlafaxine, Venlafaxine ER, Bupropion SR, Mirtazapine, Mirtazapine ODT, Duloxetine, Pristiq
Viibryd, Brintellix
Paroxetine or Sertraline Luvox CR/Fluvoxamine ER
Any two of the following: Venlafaxine, Venlafaxine ER, Duloxetine, Pristiq
Fetzima
Bupropion SR Aplenzin
Bold type = Brand-name drug Plain type = Generic drug
Step Therapy Medications (2 steps)* Continued
Step Therapy Program
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Condition Step 1 Step 2
Diabetes Humalog or Novolog Apidra
Metformin or Metformin ER Amaryl, Diabeta, Duetact, Glucotrol, Glucotrol XR, Glucovance, Glynase, Metaglip, Prandimet, Prandin, Precose, Starlix
Any one of the following: Metformin, Metformin ER
Actoplus Met XR, Actos
Any two of the following: Metformin, Metformin ER, Metformin-glipizide, Metformin-glyburide, Metformin-pioglitazone, Chlorpropamide, Glimepiride, Glipizide, Glipizide ER, Glyburide, Tolazamide, Tolbutamide, Pioglitazone, Pioglitazone-glimepiride, Novolog, Lantus, Humalog, Levemir, Humulin, Novolin, Byetta
Glyset
Any one of the following: Metformin, Metformin ER, Metformin-glipizide, Metformin-glyburide, Metformin-pioglitazone, Chlorpropamide, Glimepiride, Glipizide, Glipizide ER, Glyburide, Tolazamide, Tolbutamide, Pioglitazone, Pioglitazone-glimepiride, Novolog, Lantus, Humalog, Levemir, Humulin, Novolin, Byetta
Riomet
Ear Condition Ofloxacin Cetraxal/Ciprofloxacin
Gastrointestinal (Miscellaneous)
Creon and Zenpep Viokace, Pancreaze, Pertzye, Ultresa
Polyethylene Glycol or Lactulose Amitiza, Linzess
Gout Allopurinol Uloric
Insomnia Zolpidem or Zolpidem CR Intermezzo, Edluar, Zolpimist
Bold type = Brand-name drug Plain type = Generic drug
Step Therapy Medications (2 steps)* Continued
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Condition Step 1 Step 2
Migraine Rizatriptan (tablet)/Rizatriptan RDT, Sumatriptan (tablet), Zolmitriptan (tablet)/Zolmitriptan ODT
Treximet
Skin Conditions (Miscellaneous)
Any one of the following topical corticosteroids: Alclometasone, Betamethasone Dipropionate (augmented), Betamethasone Dipropionate, Clobetasol, Desonide, Desoximetasone, Diflorasone, Fluocinolone, Fluocinonide, Fluticasone, Hydrocortisone, Mometasone, Triamcinolone, Pramosone
Elidel, Protopic
Narcotic Analgesics
Any one of the following: Morphine Sulfate CR, Morphine Sulfate SR, Oxycontin
Exalgo
Tramadol or Tramadol-acetaminophen
Tramadol ER
Nausea/Vomiting
Metoclopramide Metozolv ODT
Neurologic Any one of the following: Amitriptyline, Cyclobenzaprine, Duloxetine, Lyrica
Savella
Gabapentin Gralise
Non-Narcotic Analgesics
Any one of the following: Diclofenac, Etodolac, Fenoprofen, Flurbiprofen, Ibuprofen, Indomethacin, Ketoprofen, Ketorolac, Meloxicam, Nabumetone, Naproxen, Oxaprozin, Piroxicam, Sulindac, Tolmetin
Duexis
Oncology Fluorouracil or Imiquimod Picato
Opthalamic Agents
Any one of the following: Azelastine, Patanol, Pataday
Bepreve, Lastacaft
Osteoporosis Alendronate Atelvia
Bold type = Brand-name drug Plain type = Generic drug
Step Therapy Medications (2 steps)* Continued
Step Therapy Program
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Condition Step 1 Step 2
Overactive Bladder
Any two of the following: Oxybutynin, Vesicare, Oxytrol, Gelnique
Detrol/Tolterodine, Sanctura/Trospium, Sanctura XR/Trospium ER, Detrol LA/Tolterodine SR, Myrbetriq
Parkinson's Disease
Ropinorole or Pramipexole Requip XL/Ropinirole ER, Mirapex ER
Prostatic Hypertrophy
Any two of the following: Alfuzosin, Doxazosin, Terazosin, Tamsulosin, Rapaflo
Cardura XL
Severe Allergic Reaction
Epipen, Epipen Jr Epinephrine, Auvi-Q, Adrenaclick
Ulcer/Acid Reflux
Any two of the following: Omeprazole, Lansoprazole (capsule), Pantoprazole, Nexium, Dexilant
Esomeprazole Strontium, Lansoprazole Suspension, Prevacid, Prevacid ODT/Lanosprazole ODT, First-Omeprazole Suspension, Aciphex/Rabeprazole, Zegerid/ Omeprazole-sodium Bicarbonate, Prilosec, Protonix
Omeclamox or Pylera Prevpac/Lansoprazole-amoxicillin-clarithromycin, Helidac
Bold type = Brand-name drug Plain type = Generic drug
Step Therapy Medications (3 steps)*
If you have a prescription for any of the following Step 3 medications, you must first try Step 1 and Step 2 medications for benefit coverage.
Condition Step 1 Step 2 Step 3
Asthma /COPD Any one of the following: Theophylline, Qvar, Pulmicort, Flovent Diskus, Flovent HFA, Asmanex, Tudorza, Atrovent HFA, Spiriva, Advair Diskus, Advair HFA, Symbicort, Theo-24
Foradil and Serevent
Arcapta
Bold type = Brand-name drug Plain type = Generic drug
Step Therapy Medications (2 steps)* Continued
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Condition Step 1 Step 2 Step 3
Cardiovascular Any one of the following: Benazepril, Candesartan, Captopril, Enalopril, Fosinopril, Irbesartan, Lisinopril, Moexipril, Perindopril, Quinapril, Ramipril, Telmisartan, Trandolapril, Benazepril-amlodipine, Trandolapril-verapamil, Benazepril-HCTZ, Captopril-HCTZ, Enalapril-HCTZ, Fosinopril-HCTZ, Irbesartan-HCTZ, Lisinopril-HCTZ, Moexipril-HCTZ, Quinapril-HCTZ, Losartan, Losartan-HCTZ
Any one of the following: Azor, Exforge, Exforge HCT
Twynsta/ Telmisartan-amlopidine
Any one of the following: Benazepril, Candesartan, Captopril, Enalopril, Fosinopril, Irbesartan, Irbesartan HCTZ, Lisinopril, Moexipril, Perindopril, Quinapril, Ramipril, Trandolapril, Benazepril-amlodipine, Trandolapril-verapamil, Telmisartan, Benazepril-HCTZ, Captopril-HCTZ, Enalapril-HCTZ, Fosinopril-HCTZ, Lisinopril-HCTZ, Moexipril-HCTZ, Quinapril-HCTZ, Losartan, Losartan-HCTZ
Tekturna or Tekturna HCT
Tekamlo, Amturnide
Any two of the following: Benicar, Benicar HCT, Diovan, Micardis HCT
Atacand, Atacand HCT/Candesartan-HCTZ, Teveten/Eprosartan, Teveten HCT, Avapro, Avalide, Cozaar, Hyzaar, Diovan HCT, Micardis
Diabetes Any one of the following: Metformin, Metformin ER, Metformin-glipizide, Metformin-glyburide, Metformin-pioglitazone, Chlorpropamide, Glimepiride, Glipizide, Glipizide ER, Glyburide, Tolazamide, Tolbutamide, Pioglitazone, Pioglitazone-glimepiride, Novolog, Lantus, Humalog, Levemir, Humulin, Novolin, Byetta
Any one of the following: Tradjenta, Onglyza, Januvia, Jentadueto, Kombiglyze, Janumet
Nesina, Kazano, Oseni
Bold type = Brand-name drug Plain type = Generic drug
Step Therapy Medications (3 steps)* Continued
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Condition Step 1 Step 2 Step 3
Diabetes Continued
Any one of the following: Metformin, Metformin ER, Metformin-glipizide, Metformin-glyburide, Metformin-pioglitazone, Chlorpropamide, Glimepiride, Glipizide, Glipizide ER, Glyburide, Tolazamide, Tolbutamide, Pioglitazone, Pioglitazone-glimepiride, Novolog, Lantus, Humalog, Levemir, Humulin, Novolin, Byetta
Janumet Janumet XR
Any one of the following: Metformin, Metformin ER, Metformin-glipizide, Metformin-glyburide, Metformin-pioglitazone, Chlorpropamide, Glimepiride, Glipizide, Glipizide ER, Glyburide, Tolazamide, Tolbutamide, Pioglitazone, Pioglitazone-glimepiride, Novolog, Lantus, Humalog, Levemir, Humulin, Novolin
Byetta, Victoza Bydureon, Tanzeum
Any one of the following: Metformin, Metformin ER, Metformin-glipizide, Metformin-glyburide, Metformin-pioglitazone, Chlorpropamide, Glimepiride, Glipizide, Glipizide ER, Glyburide, Tolazamide, Tolbutamide, Pioglitazone, Pioglitazone-glimepiride, Novolog, Lantus, Humalog, Levemir, Humulin, Novolin, Byetta
Invokamet, Invokana
Fargixa, Jardiance
Bold type = Brand-name drug Plain type = Generic drug
Step Therapy Medications (3 steps)* Continued
* Step therapy requirements are effective as of January 1, 2015. The list of step therapy medications is subject to change without notice. Step therapy requirements may vary by benefit plan. Additional clinical programs, including quantity limits and prior authorization, may exist for the above medications which may affect your prescription drug coverage.