Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Pharmacy Services)
Step Therapy Program A step therapy program is an approach to providing drug coverage.
It encourages the use of cost-effective prescription drugs, when
appropriate. This means that the member may first need to try an
alternative drug, typically a generic drug, before we will cover
certain drugs prescribed by your doctor. Step therapy programs are
developed using treatment guidelines, clinical evidence and
research. Check the member’s plan’s certificate of coverage or
other materials for benefit details.
What it means for the member or patient
If the member is currently taking a drug that’s included in our step
therapy program, please talk to your patient. Together you can
discuss which drug options are best for the patient. You can decide
whether to write a new prescription or submit a written request for
the member to remain on his/her current drug.
Drug lists and authorization form
GenRx Step Therapy program - drug list (PDF) – All users of
the GenRx formulary have step therapy. The list is subject to
change without notice.
FlexRx Step Therapy program - drug list (PDF) – Step therapy
programs for the FlexRx formulary vary based on employer
group. The list is subject to change without notice.
Step Therapy authorization form (PDF) – Your doctor must
complete and submit this form to request an exception to this
program. Your doctor can also get this form by calling
provider services at (651) 662-5200 or 1-800-262-0820.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (08/09/11)
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