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MCHCP uses step therapy to ensure members get the safest drugs at the best cost possible before moving to a more costly therapy. The step therapy program varies based on the drug prescribed and the provider's recommended treatment plan. Members may be required to try more than one first-step drug.

These drugs are noted with “ST” next to them in the formulary.

First-Step Drugs

  • Primarily generic drugs that have been proven safe and effective
  • Lowest copayment or cost applies
  • Drugs must be tried before the plan pays for a second-step drug

Second-Step Drugs

  • Drugs recommended if first-step drugs don’t work
  • Primarily brand-name drugs
  • Higher copayment or cost normally applies
  • Second-step prescriptions processed at a pharmacy for the first time trigger a message to the pharmacist indicating the use of step therapy. Members should speak with their provider about the next plan of action.

One of the following may occur:

  • The provider may decide to prescribe a first-step drug for the treatment plan.
  • If the provider decides treatment requires a second-step drug without trying a first-step drug, preauthorization must be requested from ESI. A higher copayment or coinsurance may apply.

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