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Drugs requiring step therapy

Some drugs will be approved for you only after you try other drugs first and they don't work for you. This approval requirement is called "step therapy," and the drugs that it applies to are called "step therapy drugs."

Step therapy drugs are identified in the 2012 Priority Health Medicare Formulary (425KB PDF, Form Y0056_5000_5001_14 File and Use 08122011). Here is a list of them for your convenience, also available in PDF format: Drugs that require step therapy (127KB PDF, Form Y0056_1009_1009_89 File and Use 12182011)

Drugs that require step therapy
Aciphex Must try and fail with two of omeprazole (Prilosec), lansoprazole (Prevacid), or pantoprazole (Protonix).
Altoprev Must try and fail with one of simvastatin (Zocor), pravastatin (Pravachol), or lovastatin (Mevacor), and also with Crestor.
Amturnide Must be used concurrently with an ARB.
Arcapta Must try and fail with either Foradil or Serevent.
Atacand/Atacand HCT Must try and fail with a generic ACE inhibitor or a generic ARB.
Avalide Must try and fail with a generic ACE inhibitor or a generic ARB.
Avapro Must try and fail with a generic ACE inhibitor or a generic ARB.
Avinza Must try and fail with extended release morphine sulfate (MS Contin).
Avonex Must try and fail with Copaxone or Rebif.
Azor Must try and fail with a generic ACE inhibitor or a generic ARB.
Benicar/Benicar HCT Must try and fail with a generic ACE inhibitor or a generic ARB.
Bepreve Must try and fail with one of azelastine or epinastine.
Betaseron Must try and fail with Copaxone or Rebif.
Butrans Must try and fail with 2 of the following: extended-release morphine sulfate, methadone, fentanyl patch or OxyContin.
Byetta Must try and fail with metformin at daily doses of 1500mg or greater.
Bydureon Must try and fail with metformin at daily doses of 1500mg or greater.
Caduet Must try and fail with one of simvastatin (Zocor), pravastatin (Pravachol), or lovastatin (Mevacor), and also with Crestor.
Cambia Must try and fail with generic diclofenac.
Cialis 2.5mg, 5mg Must try and fail with either tamsulosin or alfuzosin, and must try and fail with finasteride.
Clarinex Must try and fail with levocetirizine.
Coreg CR Must try and fail with immediate release carvedilol (Coreg).
Cycloset Must be used concurrently with a sulfonylurea. Not approved for patients using insulin.
Detrol/Detrol LA Must try and fail with one of oxybutynin, oxybutynin ER, or trospium chloride.
Dexilant Must try and fail with two of omeprazole, pantoprazole, or lansoprazole.
Dificid Must try and fail with vancomycin.
Diovan/Diovan HCT Must try and fail with a generic ACE inhibitor or a generic ARB.
Edarbyclor
Emadine Must try and fail with one of azelastine or epinastine.
Embeda Must try and fail with extended release morphine sulfate (MS Contin).
Emsam Must try and fail with oral selegiline.
Exalgo Must try and fail with generic morphine sulfate ER.
Exforge/Exforge HCT Must try and fail with a generic ACE inhibitor or a generic ARB.
Extavia Must try and fail with Copaxone or Rebif.
Fanapt Must try and fail with one atypical antipsychotic.
Flector Must try and fail with on generic oral NSAID.
Forteo Must try and fail with two of alendronate (Fosamax), Actonel, Boniva, or Miacalcin.
Gralise Must try and fail with gabapentin.
Glumetza Must try and fail with metformin.
Horizant Must try and fail with two of gabapentin, pramipexole and/or ropinirole.
Inlyta Must try and fail with one of Sutent, Votrient, or Nexavar.
Invega Must try and fail with one atypical antipsychotic.
Jalyn Must try and fail with both finasteride and tamsulosin.
Januvia Must try and fail with metformin at daily doses of 1500mg or greater. Januvia is not approved for members using insulin.
Juvisync Must try and fail with metformin.
Lastacaft Must try and fail with one of azelastine or epinastine.
Lescol XL Must try and fail with one of simvastatin (Zocor), pravastatin (Pravachol), or lovastatin (Mevacor), and also with Crestor.
Lexapro Must try and fail with one generic antidepressant.
Lipitor Must try and fail with one of simvastatin (Zocor), pravastatin (Pravachol), or lovastatin (Mevacor), and also with Crestor.
Livalo Must try and fail with one of simvastatin (Zocor), pravastatin (Pravachol), or lovastatin (Mevacor), and also with Crestor.
Lumigan Must try and fail with latanoprost or brimonidine tartrate.
Lunesta Must try and fail with zolpidem (Ambien) or zaleplon (Sonata).
Luvox CR Must try and fail with generic fluvoxamine (Luvox).
Metozolv ODT Must try and fail with generic metoclopramide (Reglan).
Micardis/Micardis HCT Must try and fail with a generic ACE inhibitor or a generic ARB.
Mirapex ER Must try and fail with generic pramipexole.
Nexium Must try and fail with two of omeprazole, pantoprazole, or lansoprazole.
Oleptro ER Must try and fail with immediate release trazodone.
Onglyza Must try and fail with metformin.
Oravig Must try and fail with one of clotrimazole troches or nystatin suspension.
Oxytrol Must try and fail with oxybutynin (Ditropan) or oxybutynin ER (Ditropan XL).
Pataday Must try and fail with one of azelastine or epinastine.
Patanol Must try and fail with one of azelastine or epinastine.
Phoslyra Must try and fail with calcium acetate (generic PhosLo).
Picato Must try and fail with one of imiquimod or fluorouracil.
Pristiq Must try and fail with one generic SSRI, SNRI, or tricyclic antidepressant, and must try and fail with venlafaxine ER.
Rapaflo Must try and fail with tamsulosin or finasteride.
Regranex Must be on medications to treat diabetes.
Renvela Must try and fail with calcium acetate (generic PhosLo).
Requip XL Must try and fail with generic ropinirole (Requip).
Rozerem Must try and fail with zolpidem (Ambien) or zaleplon (Sonata).
Sanctura XR Must try and fail with trospium chloride.
Saphris Must try and fail with one atypical antipsychotic.
Silenor Must try and fail with one of doxepin capsule or trazodone.
Stavzor Must try and fail with generic valproic acid.
Symlin Must be using rapid-acting insulin.
Tekamlo Must try and fail with an ARB.
Tekturna Must try and fail with an ARB.
Tekturna HCT Must try and fail with an ARB.
Teveten/Teveten HCT Must try and fail with a generic ACE inhibitor or a generic ARB.
Tirosint Must try and fail with generic levothyroxine.
Toviaz Must try and fail with one of oxybutynin, oxybutynin ER or trospium chloride.
Tradjenta Must try and fail with metformin for 3 of the last 4 months.
Tribenzor Must try and fail with a generic ACE inhibitor or a generic ARB.
Twynsta Must try and fail with a generic ACE inhibitor or a generic ARB.
Uloric Must try and fail with allopurinol.
Uroxatral Must try and fail with tamsulosin or finasteride.
Valturna Must be using one other antihypertensive medication.
Vectical Must try and fail one generic, high-potency topical steroid.
Vesicare Must try and fail with one of oxybutynin, oxybutynin ER or trospium chloride.
Victoza Must be used concurrently with metformin.
Viibryd Must try and fail with one generic antidepressant.
Vimovo Must try and fail with two of omeprazole, pantoprazole, or lansoprazole.
Voltaren Gel Must try and fail with on generic oral NSAID.
Vytorin Must try and fail with one of simvastatin (Zocor), pravastatin (Pravachol), or lovastatin (Mevacor), and also with Crestor.
Zipsor Must try and fail with generic diclofenac.
Zolpimist Must try and fail with zolpidem tablets.
Zonalon Must try and fail with one generic topical corticosteroid.
Zyclara Must try and fail with imiquimod.
Zymaxid Must try and fail with Zymar or Vigamox.

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