Step Therapy is a prior authorization program that encourages the use of less costly yet effective medications before more costly medications are approved for coverage. Health care providers may be able to choose from several different safe and effective prescription medications to treat an individual's condition. Cost is often the biggest difference. Generic medications, which have the same quality, strength, purity and stability as brand name medications, typically cost less than brand name medications.
Step Therapy medications are grouped into "steps." Though the Step Therapy requirements vary by condition, in general, an individual is required to try at least one or more Step 1 and/or Step 2 medications before a Step 3 medication is eligible for coverage without prior authorization.
Drugs included in the Step Therapy program are typically considered therapeutic alternatives to each other for their respective step therapy group. Therapeutic alternatives (drug protocols with different chemical structures that are the same therapeutic or pharmacological class, and usually can be expected to have similar outcomes and adverse reaction profiles when administered in therapeutically equivalent doses) are determined from FDA approved product information and pharmaceutical compendia sources. Exceptions for specific indications or uses are noted in the respective clinical criteria within each coverage policy linked below.
Please reference one the following Cigna Drug and Biologic Coverage Policies for additional information, including the list of affected drug categories:
- Step Therapy - (1109)
- Step Therapy Individual and Family Plan - (1603)
- Cigna Drug and Biologic Coverage Policy 1801 (Step Therapy – Standard Prescription Drug Lists (Employer Group Plans))
- Cigna Drug and Biologic Coverage Policy 1802 (Step Therapy - Value Prescription Drug Lists (Employer Group Plans))
- Cigna Drug and Biologic Coverage Policy 1803 (Step Therapy – Legacy Prescription Drug Lists (Employer Group Plans))