Certain medical conditions can be treated using a variety of medications. In some cases, there is a very large difference in cost among the medications, but a very small difference in the way the medications work.
Unity’s Step Therapy Program is approved by the Pharmacy and Theraputics (P&T) Committee and requires a member to try the more cost-effective medications before receiving coverage for (or "stepping up to") the more expensive medications. Many members find the first medication very effective and never need to step up.
Step therapy medications require Prior Authorization for coverage. Requests for Prior Authorization for step therapy medications are reviewed on a case-by-case basis. Each medication has specific requirements for approval, which are established by the P&T Committee. Formulary or non-formulary drugs may be included in the Step Therapy Program. To see which medications have step therapy requirements, refer to your Unity Prescription Drug Formulary. Drugs marked with "ST" require step therapy.
