Responsible Steps Program Information and Authorization Forms
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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).
No material changes to policy (has_material_change=false).
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.
General Program Rules
Antidepressants — Initial Criteria
Atypical Antipsychotics — Initial Criteria
Atypical Antipsychotics
Target drugs and prerequisite requirement:
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:
Also links Dexcom and FreeStyle systems to these SGLT2 targets.
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:
Target examples: Auryxia, Ferric Citrate 210 mg tablet
Miscellaneous Mappings
Miscellaneous
Other mappings and prerequisites:
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:
Target examples: Elidel cream, Eucrisa ointment, pimecrolimus cream, tacrolimus ointment
See groups listing for specific agents and two‑or‑more generic requirement.
Provider Actions & Authorization Requirements
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).
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).
Applicable Codes
| No codes listed |
| 00713-0223-15 | Fluocinolone acetonide 0.01% cream (NDC example in policy) |
| 00713-0223-60 | Fluocinolone acetonide 0.01% cream (NDC example in policy) |
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.
Revision History
Most recent policy review of the Responsible Steps Program (Current 4/1/26).
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