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    v1.0.28
    OpenPayerPolicy UpdatesPharmacy & Specialty DrugsCHRISTUS Health Plan Step Therapy Coverage | OpenP…
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    CurrentCHRISTUS Health PlanPolicy H1189_MC7954_C

    2026 Premier Performance Standard Step Therapy

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    This policy governs step-therapy coverage requirements for certain drugs covered under CHRISTUS Health Medicare Complete and CHRISTUS Health Medicare Plus plans. Coverage is provided after the member has tried the specified generic or preferred alternative therapy for the required duration.

    Policy Summary
    PayerCHRISTUS Health Plan
    Policy2026 Premier Performance Standard Step Therapy
    Policy CodePolicy H1189_MC7954_C
    Change TypeNo material change
    Effective DateN/A
    Next Review DateN/A
    Key ActionBefore coverage, verify that the required generic or preferred alternative therapy was tried for at least 30 days.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    8step therapy groups
    30 daysminimum trial duration
    2 of 3esomeprazole alternatives
    8target drug entries

    Step Therapy Coverage Criteria

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    Step Therapy Coverage Criteria

    Coverage will be provided when the required prior therapy has been tried for the applicable step therapy group.

    ARIPIPRAZOLE ODT — Drug: ARIPIPRAZOLE ODT

    • At least a 30-day supply of generic aripiprazole immediate release tablet has been tried.

    BARACLUDE SOL — Drug: BARACLUDE

    • At least a 30-day supply of generic entecavir tablets has been tried.

    BRINZOLAMIDE — Drug: BRINZOLAMIDE

    • At least a 30-day supply of dorzolamide 2% ophthalmic solution has been tried.

    LAMOTRIGINE — Drugs: LAMOTRIGINE ER, SUBVENITE

    • At least a 30-day supply of generic lamotrigine immediate release tablets or generic lamotrigine chewable, dispersible tablet has been tried.

    LEVALBUTEROL — Drug: LEVALBUTEROL TARTRATE HFA

    • At least a 30-day supply of albuterol HFA or Ventolin HFA has been tried.

    OLANZAPINE ODT — Drug: OLANZAPINE ODT

    • At least a 30-day supply of generic olanzapine immediate release tablet has been tried.

    PPI — Drug: ESOMEPRAZOLE MAGNESIUM

    • At least TWO of the following generic alternatives

      • Omeprazole capsules have been tried for at least a 30-day supply.
      • Pantoprazole tablets have been tried for at least a 30-day supply.
      • Lansoprazole capsules have been tried for at least a 30-day supply.

    RISPERIDONE ODT — Drug: RISPERIDONE ODT

    • At least a 30-day supply of generic risperidone immediate release tablet has been tried.

    Required Prior Therapy

    Step Therapy

    Generic Aripiprazole Trial Required

    Coverage will be provided when the member has tried at least a 30-day supply of generic aripiprazole immediate-release tablets.

    • Affected drug: ARIPIPRAZOLE ODT
    Step Therapy

    Generic Entecavir Trial Required

    Coverage will be provided when the member has tried at least a 30-day supply of generic entecavir tablets.

    • Affected drug: BARACLUDE
    Step Therapy

    Dorzolamide Trial Required

    Coverage will be provided when the member has tried at least a 30-day supply of dorzolamide 2% ophthalmic solution.

    • Affected drug: BRINZOLAMIDE
    Step Therapy

    Generic Lamotrigine Trial Required

    Coverage will be provided when the member has tried at least a 30-day supply of generic lamotrigine immediate-release tablets or generic lamotrigine chewable, dispersible tablets.

    • Affected drugs: LAMOTRIGINE ER and SUBVENITE
    Step Therapy

    Albuterol or Ventolin Trial Required

    Coverage will be provided when the member has tried at least a 30-day supply of albuterol HFA or Ventolin HFA.

    • Affected drug: LEVALBUTEROL TARTRATE HFA
    Step Therapy

    Generic Olanzapine Trial Required

    Coverage will be provided when the member has tried at least a 30-day supply of generic olanzapine immediate-release tablets.

    • Affected drug: OLANZAPINE ODT
    Step Therapy

    Two Generic PPI Trials Required

    Coverage will be provided when the member has tried at least a 30-day supply of two specified generic alternatives.

    • Affected drug: ESOMEPRAZOLE MAGNESIUM
    • Required alternatives: omeprazole capsules, pantoprazole tablets, or lansoprazole capsules
    • At least two alternatives must have been tried for 30 days.
    Step Therapy

    Generic Risperidone Trial Required

    Coverage will be provided when the member has tried at least a 30-day supply of generic risperidone immediate-release tablets.

    • Affected drug: RISPERIDONE ODT
    Denial Risk

    Required Step Therapy Not Completed

    Coverage may be denied when the required generic or preferred therapy has not been tried for the specified minimum duration. Confirm and document completion of the applicable step-therapy requirement before requesting coverage.

    • Required duration: at least 30 days
    • For esomeprazole magnesium, two listed generic alternatives must each meet the required trial condition.

    Initial Therapy Requirements

    Aripiprazole ODT

    Coverage will be provided after the required alternative therapy has been tried.

    Aripiprazole ODT prerequisite

    • Generic aripiprazole immediate-release tablet has been tried.At least a 30-day supply

    Baraclude

    Coverage will be provided after the required alternative therapy has been tried.

    Baraclude prerequisite

    • Generic entecavir tablets have been tried.At least a 30-day supply

    Brinzolamide

    Coverage will be provided after the required alternative therapy has been tried.

    Brinzolamide prerequisite

    • Dorzolamide 2% ophthalmic solution has been tried.At least a 30-day supply

    Lamotrigine ER and Subvenite

    Coverage will be provided after the required alternative therapy has been tried.

    Lamotrigine prerequisite

    • Generic lamotrigine immediate-release tablets have been tried.At least a 30-day supply
    • Generic lamotrigine chewable, dispersible tablet has been tried.At least a 30-day supply

    Levalbuterol tartrate HFA

    Coverage will be provided after the required alternative therapy has been tried.

    Levalbuterol prerequisite

    • Albuterol HFA has been tried.At least a 30-day supply
    • Ventolin HFA has been tried.At least a 30-day supply

    Olanzapine ODT

    Coverage will be provided after the required alternative therapy has been tried.

    Olanzapine ODT prerequisite

    • Generic olanzapine immediate-release tablet has been tried.At least a 30-day supply

    Esomeprazole magnesium

    Coverage will be provided after the required alternative therapies have been tried.

    PPI prerequisites

    • Generic omeprazole capsules have been tried.At least a 30-day supply
    • Generic pantoprazole tablets have been tried.At least a 30-day supply
    • Generic lansoprazole capsules have been tried.At least a 30-day supply

    Risperidone ODT

    Coverage will be provided after the required alternative therapy has been tried.

    Risperidone ODT prerequisite

    • Generic risperidone immediate-release tablet has been tried.At least a 30-day supply

    Preferred and Generic Alternatives

    StepRequired therapyTarget drugMinimum trial duration
    1Generic aripiprazole immediate-release tabletAripiprazole ODTAt least 30 days
    StepRequired therapyTarget drugMinimum trial duration
    1Generic entecavir tabletsBaracludeAt least 30 days
    StepRequired therapyTarget drugMinimum trial duration
    1Dorzolamide 2% ophthalmic solutionBrinzolamideAt least 30 days
    StepRequired therapyTarget drugMinimum trial duration
    1Generic lamotrigine immediate-release tablets or generic lamotrigine chewable, dispersible tabletsLamotrigine ER or SubveniteAt least 30 days
    StepRequired therapyTarget drugMinimum trial duration
    1Albuterol HFA or Ventolin HFALevalbuterol tartrate HFAAt least 30 days
    StepRequired therapyTarget drugMinimum trial duration
    1Generic olanzapine immediate-release tabletOlanzapine ODTAt least 30 days
    StepRequired therapyTarget drugMinimum trial duration
    1Two of the following generic alternatives: omeprazole capsules, pantoprazole tablets, or lansoprazole capsulesEsomeprazole magnesiumAt least 30 days
    StepRequired therapyTarget drugMinimum trial duration
    1Generic risperidone immediate-release tabletRisperidone ODTAt least 30 days
    Policy Summary
    PayerCHRISTUS Health Plan
    Policy2026 Premier Performance Standard Step Therapy
    Policy CodePolicy H1189_MC7954_C
    Change TypeNo material change
    Effective DateN/A
    Next Review DateN/A
    Key ActionBefore coverage, verify that the required generic or preferred alternative therapy was tried for at least 30 days.
    SourceLink
    On This Page
    Step Therapy Coverage CriteriaRequired Prior TherapyInitial Therapy RequirementsPreferred and Generic Alternatives