Certain prescription drugs may be subject to step therapy. Step therapy means a member needs to try the drug(s) listed as a first-line drug, before being allowed to be prescribed a second-line drug. Gundersen Health Plan has implemented step therapy programs in several drug classes where generics or lower cost brand name drugs are available and equally effective. These medications are identified within the Formulary.
If there is medical documentation and/or prescription history to indicate the first-line drug was unsuccessful, or that you are unable to attempt a trial of the first line drug, your physician may submit a drug prior authorization for review. If approved, the authorization will allow you to move directly to the second-line drug in that drug class.