Step Therapy

The main goal of Step Therapy is to promote safer, more cost-effective treatment by encouraging a “step” approach in evaluating prescription drug use. To receive the maximum plan benefit, you may first need to try a proven, cost-effective option before engaging in a newer treatment that may be higher-cost and higher-risk.

If your doctor determines that a first-line drug is not right for you, then your prescription drug benefit will cover second-line drugs, which are often less-preferred and more expensive.

Prior Authorization is required for certain high-cost, high-risk drugs, including those with the greatest potential for misuse. Before medications on the Prior Authorization list can be covered under your plan, your doctor will need to give approval.

If you have questions about Step Therapy or Prior Authorization, please call the Pharmacy Program number on the back of your Memorial Hermann Health Plan or Memorial Hermann Insurance ID card.