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.
