Step therapy

Priority Health has some drug categories that require a therapeutic trial of a specific drug or drug(s) before authorization will be granted for other medications. This process is commonly referred to as step therapy.

Here are some examples of common drug classes for the commercial formulary (HMO, PPO, POS) that require step therapy:

• Angiotensin receptor blockers: requires the documented therapeutic trial and clinical failure of an ACE Inhibitor, except when the patient has diabetes.
• Nasal steroids: requires use of fluticasone or flunisolide first-line, followed by Nasacort AQ or Rhinocort AQ as second-line. Non-preferred nasal steroids include Nasonex, Veramyst, Omnaris and Beconase AQ.
• Antidepressants: requires the use of one generic antidepressant before a claim for Lexapro or Cymbalta is allowed.

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