CurrentFlorida BluePolicy N/A

Responsible Steps Program Information and Authorization Forms

Provides lists of target drugs by therapeutic category and the prerequisite prior-use (step) medications required for prior authorization within the Responsible Steps Program; links to authorization forms are referenced. Covers many classes (antidepressants, atypical antipsychotics, gabapentin-related products, SGLT2 inhibitors, phosphate binders, topical corticosteroids, atopic dermatitis agents, etc.) and specifies required prior use (generic agents, number required, or condition-specific alternatives).

Policy Summary

PayerFlorida Blue

PolicyResponsible Steps Program Information and Authorization Forms

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionProviders must use the authorization form that matches the therapeutic category of the target drug and document prior use of the specific generic prerequisite drugs as listed for the target drug and indication.

SourceLink

POLICY UPDATE CHANGES

No material changes to policy (has_material_change=false).

MultipleTherapeutic categories covered

ManyTarget drugs listed

SpecificPrerequisite prior-use requirements

Coverage Summary

The Responsible Steps Program requires documented prior-use (step) therapies before target drugs will be authorized; it maps many target drugs across therapeutic categories to specified prerequisite generic alternatives or alternative agents and references category-specific authorization forms. Coverage stance: covered with criteria when the listed prerequisite prior-use requirements are met.

Atypical Antipsychotics — Initial Criteria

Atypical Antipsychotics

Target drugs and prerequisite requirement:

Atypical antipsychotics prerequisites: Previous use of two or more generic versions of aripiprazole, clozapine, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, or ziprasidone. *Lybalvi requires only one generic.

Target examples: Abilify, Abilify MyCite, Fanapt, Fanapt titration pack, Geodon, Invega, Lybalvi, Opipza, Quetiapine 150 mg IR tablet, Risperdal, Risperidone 0.25 mg ODT, Saphris, Secuado, Seroquel, Seroquel XR, Symbyax, Versacloz, Zyprexa, Zyprexa Zydis.

SGLT2 Inhibitors — Prerequisites

SGLT2 Inhibitors and related prerequisites

Links target SGLT2 drugs to prerequisite documentation of prior therapy:

SGLT2 targets mapping to insulin/metformin prerequisites: For listed SGLT2 targets (bexagliflozin, Brenzavvy, Glyxambi, Invokamet, Invokamet XR, Invokana, Qtern, Segluromet, Steglatro, Steglujan, Synjardy, Synjardy XR, Trijardy XR, Xigduo XR) requirement = current use of insulin or insulin combination product OR current or previous use of brand or generic versions of insulin or metformin (alone or in combination).

Also links Dexcom and FreeStyle systems to these SGLT2 targets.

Additional SGLT2 targets with broader concomitant therapy requirements: For dapagliflozin, Farxiga, Inpefa, Jardiance requirement = current use of insulin or insulin combination product OR current or previous use of brand or generic versions of insulin, metformin, ACE inhibitor, ARB, ANRI (e.g., Entresto), If channel inhibitor (e.g., Corlanor), aldosterone antagonist, beta blocker, isosorbide dinitrate, or hydralazine (alone or part of a combination product).

Target examples: Dapagliflozin, Farxiga, Inpefa, Jardiance; also associated with Dexcom/FreeStyle system listings.

Phosphate Binders — Prerequisites

Phosphate Binders

Prerequisite prior use rules for phosphate binders and substitutes:

Non-targeted phosphate binder plus Auryxia required for some targets: Previous use of BOTH a non-targeted generic phosphate binder (such as calcium acetate, calcium carbonate, calcium carbonate‑magnesium acetate, lanthanum carbonate, sevelamer HCl, or sevelamer carbonate) AND Auryxia is required for targets: Fosrenol, Renvela, Velphoro.

Auryxia prerequisites (alternative options): For Auryxia (and Ferric Citrate 210 mg tablet authorized generic of Auryxia) previous use of EITHER a generic iron supplement OR a non‑targeted generic calcium‑containing phosphate binder is required; some mappings also list combination of generic iron supplement OR non‑targeted binder AND Auryxia.

Target examples: Auryxia, Ferric Citrate 210 mg tablet

Miscellaneous Mappings

Miscellaneous

Other mappings and prerequisites:

Kerendia prerequisite: Previous use of any product containing an SGLT2 inhibitor (examples: Farxiga, Jardiance, Synjardy, Synjardy XR, Glyxambi, Trijardy XR) is required for Kerendia.

Target example: Kerendia

Topical Drugs, Atopic Dermatitis, and Topical Corticosteroids

Topical Drugs / Atopic Dermatitis / Topical Corticosteroids

Defines target topical agents and prerequisite topical steroid use by potency groups:

Atopic dermatitis agents prerequisite: Previous use of a topical corticosteroid or topical corticosteroid combination product (including but not limited to betamethasone, clobetasol, desonide, desoximetasone, fluocinolone, fluocinonide, hydrocortisone, triamcinolone, diflorasone, or mometasone) is required prior to coverage of atopic dermatitis agents.

Target examples: Elidel cream, Eucrisa ointment, pimecrolimus cream, tacrolimus ointment

Topical corticosteroids potency groups and two-or-more generic requirement: For many potency groups the policy requires previous use of two or more generic versions of listed agents. Example groups from Super‑High (Group 1) through Lowest (Group 7) list specific agents and note the 'previous use of two or more generic versions' requirement where specified (e.g., Group 1 Super‑High: betamethasone dipropionate (augmented) 0.05% gel, Diprolene 0.05% ointment; Group 6 Low Potency includes fluocinolone acetonide 0.01% cream with specified NDCs).

See groups listing for specific agents and two‑or‑more generic requirement.

Provider Actions & Authorization Requirements

Prior Authorization

Submit authorization form by therapeutic category

Providers must submit the prior authorization request using the authorization form that matches the therapeutic category of the target drug. The program references a page listing authorization forms — select the document matching the therapeutic category of the drug (for example, select the Antidepressants document for Cymbalta).

Documentation Required

Document prior use of prerequisite drugs

Document the member’s prior use of the specific prerequisite generic drug(s) or combinations listed for the target drug and indication. Where the policy specifies a required count (for example, “two or more generic versions” for many topical corticosteroid potency groups or antidepressant requirements for some targets), include documentation of the number and identity of prior generics used. Also document indication‑specific alternatives when listed (for example neuropathic pain, fibromyalgia, or chronic musculoskeletal pain alternatives for Cymbalta).

Definitions

Target Drug: The drug included in the Responsible Steps Program for which prior authorization and prerequisite use are defined.

Prerequisite Drugs: Specified generic drug(s) or prior therapies that must have been used before authorization of the target drug.

The Responsible Steps Program defines prerequisite (step) therapies required for prior authorization of target drugs and maps each target drug to specific prior-use requirements by therapeutic category; providers must submit the authorization form matching the therapeutic category and document prior use of the specified prerequisite drugs as listed for each target drug and indication.

Clinical Evidence & Rationale

This brief summarizes how the policy maps step-therapy prerequisites to individual target drugs across therapeutic categories. Specific clinical evidence citations or trial metric details are not included in this brief.

Policy Summary

PayerFlorida Blue

PolicyResponsible Steps Program Information and Authorization Forms

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

SourceLink

On This Page

00713-0223-15	Fluocinolone acetonide 0.01% cream (NDC example in policy)
00713-0223-60	Fluocinolone acetonide 0.01% cream (NDC example in policy)

OpenPayer

Responsible Steps Program Information and Authorization Forms

Coverage Summary

General Program Rules

Antidepressants — Initial Criteria

Atypical Antipsychotics — Initial Criteria

SGLT2 Inhibitors — Prerequisites

Phosphate Binders — Prerequisites

Miscellaneous Mappings

Topical Drugs, Atopic Dermatitis, and Topical Corticosteroids

Provider Actions & Authorization Requirements

Applicable Codes

Definitions

Clinical Evidence & Rationale

Revision History

Responsible Steps Program Information and Authorization Forms

Coverage Summary

General Program Rules

Antidepressants — Initial Criteria

Atypical Antipsychotics — Initial Criteria

Gabapentin-Related Products & Indications

SGLT2 Inhibitors — Prerequisites

Phosphate Binders — Prerequisites

Miscellaneous Mappings

Topical Drugs, Atopic Dermatitis, and Topical Corticosteroids

Provider Actions & Authorization Requirements

Applicable Codes

Definitions

Clinical Evidence & Rationale

Revision History