HealthChoice Medicare Supplement Plans
Step Therapy – Trying a Different Drug First
Step Therapy requires you to first try a designated drug(s) to treat your medical condition before the Plan covers another drug for that same condition. For example, if Drug A and Drug B both treat the same medical condition, the Plan may require you to try Drug A first. If Drug A is not effective, the Plan will then cover Drug B.
If you have questions about Step Therapy, please contact Express Scripts at:
- Members with Part D call toll-free 1-800-590-6828 or TDD users call toll-free 1-800-716-3231
- Members without Part D call toll-free 1-800-903-8113 or TDD users call toll-free 1-800-825-1230
Medications Requiring Step Therapy
||If the patient has tried two Step 1 drugs, then authorization for a Step 2 drug may be given. Step 1 Drug(s): Diclofenac-misoprostol, Diclofenac Potassium, Diclofenac Sodium, Etodolac, Fenoprofen Calcium, Flurbiprofen, Ibuprofen, Indomethacin, Ketoprofen, Meclofenamate Sodium, Mefenamic Acid, Meloxicam, Nabumetone, Naproxen, Naproxen Sodium, Oxaprozin, Piroxicam, Sulindac, Tolmetin Sodium. Step 2 Drug(s): Celebrex. Authorization for Celebrex may be given if the patient has tried two oral prescription strength NSAIDs (brand or generic) for the current condition. This step therapy program will exclude participants with a claims history of warfarin (Coumadin) or dabigatran within the last 130 days. Authorization for Celebrex may be given for patients who are currently taking chronic systemic corticosteroid therapy, warfarin (Coumadin), clopidogrel (Plavix), prasugrel (Effient), ticagrelor (Brilinta), rivaroxaban (Xarelto), dabigatran (Pradaxa), chronic aspirin therapy, fondaparinux, or low molecular weight heparins. Authorization for Celebrex may be given for patients aged greater than 75 years who are requesting Celebrex for a chronic condition.