Benign Prostatic Hyperplasia — Alpha Blockers Step Therapy
Defines step therapy requirements for alpha blocker medications used to treat benign prostatic hyperplasia (BPH) for Cigna-administered health benefit plans; affects prescribers and patients seeking coverage for listed Step 2 products.
No material clinical or coverage changes in this revision.
Coverage Criteria — Step Therapy for Alpha Blockers
Initial Step Therapy
Covered when ALL of the following are met:
If the Step Therapy rule is not met for a Step 2 Product at the point of service, coverage will be determined by the Step Therapy criteria. All approvals are provided for 1 year in duration; any other exception is considered not medically necessary.
This Step Therapy program requires a trial of a Step 1 product before coverage of a Step 2 alpha blocker will be considered. Per policy, Step 2 products are covered only when the patient has tried one Step 1 product. All prior authorization approvals for Step 2 products are provided for 1 year in duration.
Exceptions to the Step Therapy requirements are not automatically allowable. Any use not meeting the Step Therapy criteria (i.e., no trial of a Step 1 product) is considered not medically necessary, and exceptions will only be considered if approval is granted in accordance with the policy criteria.