CurrentBlue Cross Blue Shield - OklahomaPolicy N/A

Step Therapy Programs for Members on the Performance Drug List

Lists drug categories and example prescription drugs that may be subject to step therapy programs under the plan's prescription drug benefit. Explains exception review process and contact instructions.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyStep Therapy Programs for Members on the Performance Drug List

Policy CodePolicy N/A

Change TypeClarified (examples listed)

Effective Date

Next Review Date

Key ActionIf a drug is not on the Drug List or an exception is sought, the member or prescriber must request an exception review; approval may require meeting the step therapy program criteria for that drug.

POLICY UPDATE CHANGES

Provides examples of drug categories and specific medications that may be included in step therapy programs as part of the prescription drug benefit.

15+Example Drugs Listed

multipleDrug Categories

Summary of Changes

This bulletin identifies example medications within several therapeutic categories that may be subject to step therapy under the plan's prescription drug benefit and instructs members/providers on exception requests. It notes that the listed drugs are examples and the program is subject to change.

This bulletin lists example medications by therapeutic category that may be subject to step therapy and explains the exception request process. These examples are not exhaustive and the program is subject to change; additional drugs may be added.

Scope and Coverage Stance

Lists drug categories and example prescription drugs that may be subject to step therapy programs under the plan's prescription drug benefit. Drugs on the Performance Drug List may be subject to step therapy.

Coverage stance: mixed.

General Step Therapy Requirement

Step therapy programs may apply to drugs on the Performance Drug List; exception requests may be submitted and require meeting step criteria:

Drug on Performance Drug List: Drug is on the Performance Drug List (examples provided by category).
Third-party brand names are the property of their respective owners; programs are subject to change and additional drugs may be added.
Exception Request: Member or prescribing provider may request an exception review.
If your drug is not on the Drug List, you or your prescribing health care provider can ask for an exception review.
Exception Review May Require Step Criteria: As part of exception review, member may have to meet the drug's step therapy program criteria before approval.
How to Start Review: To start review, call the number on Member ID card or provider may visit bcbsok.com/provider.

Placeholder

Actions for Providers and Members

Step Therapy

Exception review / step therapy adherence

If a drug is not on the Drug List or you are seeking an exception, the member or prescribing provider must request an exception review. Approval of an exception may require meeting the drug’s step therapy program criteria before the request can be approved.

Documentation Required

Contact for questions and start of review

To initiate an exception review, call the phone number on the member’s ID card or have the prescribing provider visit bcbsok.com/provider to start the review.

bcbsok.com/provider
Member ID card phone number

Key Definitions and Common Questions

Performance Drug List: A list of drugs for which step therapy programs may be applied under the prescription drug benefit (examples provided in this bulletin).

Q: How do I request an exception to step therapy?

A: Call the number on your member ID card or have your provider visit bcbsok.com/provider to start an exception review; you may need to meet step therapy criteria as part of the review.