Asset Publisher


print Print Back Back

Step Therapy Supplement Step Therapy Program Summary

Policy Number: PH-1211

This program applies to Blue Partner, Commercial, GenPlus, NetResults A series, SourceRx and Health Insurance Marketplace formularies. 


Effective Date

Date of Origin   




See package insert for FDA prescribing information:



The intent of the Step Therapy Supplement allows members to bypass step-therapy protocol under the policy for a covered prescription drug if the member meets the following:

  1. Previous approval to receive the prescription drug through the completion of a step-therapy protocol required by a separate health coverage plan AND
  2. Provides documentation originating from the health coverage plan that approved the prescription drug indicating that the health coverage plan paid for the drug on the member's behalf during the 90 days immediately before the request

Criteria For Step Therapy Protocol

The following will be added as a notation when Step Therapy Supplement requirements apply:

*Step therapy requirement may not apply if a prior health plan paid for the medication - documentation of a paid claim may be required.

This pharmacy policy is not an authorization, certification, explanation of benefits or a contract. Eligibility and benefits are determined on a case-by-case basis according to the terms of the member’s plan in effect as of the date services are rendered. All pharmacy policies are based on (i) information in FDA approved package inserts (and black box warning, alerts, or other information disseminated by the FDA as applicable); (ii) research of current medical and pharmacy literature; and/or (iii) review of common medical practices in the treatment and diagnosis of disease as of the date hereof. Physicians and other providers are solely responsible for all aspects of medical care and treatment, including the type, quality, and levels of care and treatment.

The purpose of Blue Cross and Blue Shield of Alabama’s pharmacy policies are to provide a guide to coverage. Pharmacy policies are not intended to dictate to physicians how to practice medicine. Physicians should exercise their medical judgment in providing the care they feel is most appropriate for their patients.

Neither this policy, nor the successful adjudication of a pharmacy claim, is guarantee of payment.

BCBSAL _  Commercial _ CSReg _ Step Therapy Supplement _ST _ProgSum_ 1/1/2024