Drugs That Require Step Therapy (ST) Before Being Approved for Coverage
Defines drugs that require step therapy (ST) before HMSA Akamai Advantage (PPO) will approve coverage and instructs how to request prior authorization; applies to members and prescribers under the HMSA Akamai Advantage plan.
No material clinical or coverage changes in this revision.
Step Therapy Coverage Criteria
Step therapy general criteria
Coverage is provided when the listed alternative(s) have been tried as specified for each drug/group
Examples in the chart: aripiprazole requires generic aripiprazole immediate; entecavir requires generic entecavir tablets; dorzolamide alternative for brinzolamide; lamotrigine requires immediate-release or chewable/dispersible generics; levalbuterol requires trial of albuterol HFA or Ventolin HFA; olanzapine ODT requires trial of generic olanzapine immediate; PPI group requires two 30-day trials of specified generics.
Risperidone ODT criteria
Specific example entries
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.