Specialty Clinical Consultation List
October 5, 2023FDA Approves Zilbrysq (zilucoplan) for the Treatment of Adults with Generalized Myasthenia Gravis
October 17, 2023Step Therapy is a program designed to encourage appropriate utilization of lowest‐net‐cost medications for chronic medical conditions, helping to control healthcare costs. Step Therapy is a series of steps or medications that must be tried in a specific order. We review the prescription claim history for specific medications before the current claim can be processed to ensure the previous step has been met.
*Plan Design and Formulary Placement may affect coverage of medications listed. They supercede step therapy.
| Therapeutic Class | Disease State | 1st Line Medications | 2nd Line Medications | Rules |
|---|---|---|---|---|
| Standard | ||||
| Daliresp | COPD | roflumilast | Daliresp | Approve second line medication if patient has at least a 30 day trial of a first line medication within 180 days |
| Pulmicort Suspension | Asthma | budesonide suspension | Pulmicort suspension | Approve second line medication if patient has at least a 30 day trial of a first line medication within 180 days |
| Advair Diskus | Asthma | fluticasone/salmeterol diskus | Advair Diskus | Approve second line medication if patient has at least a 30 day trial of a first line medication within 180 days |
| Veozah | Menopausal Symptoms | Generics (hormonal and non‐ hormonal): i.e., estradiol/norethindrone, estradiol tablet, paroxetine, fluoxetine, sertraline, gabapentin, pregabalin, clonidine, etc., and Prempro, Premphase | Veozah | Approve second line medication if patient has at least 2 different first line medications, each for a 28 day trial within 180 days |