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.