How does step therapy work?

Who is this for?

Michigan Health Insurance – Customer Service – Pharmacy

Blue Cross Blue Shield of Michigan and Blue Care Network members under age 65 with prescription drug coverage.

The first questions members ask us about prescription drugs is how we're reducing costs.

One way we do that is through our step therapy program. It works to make sure you get the safest, most effective and reasonably-priced drug available.

What it is

Step therapy means trying less expensive options before "stepping up" to drugs that cost more.

Here's an example of step therapy. Let's say you're having allergy problems. You should first try using an over-the-counter medication. If that doesn't help you, try a Tier 1 medicine. If that too doesn't work, we'll review if you met the step therapy requirements before your plan will help pay for the Tier 3 medication.

Prior authorization and step therapy ensure that medically sound and cost-effective medications are prescribed appropriately. 

Where to get information

Details about prescription drugs and step therapy aren't just available to your doctor and pharmacist. They're available to you too, three different ways.

Log in to your member account on our website or the Blue Cross mobile app.

  • Go to the prescription section under My Coverage
  • On our website, select Price a Drug
  • On the app, go to My Coverage, select Prescription coverage. Then select Price a Medication from the main screen; you may have to scroll down

You'll need the name of the drug. It's helpful to know the dosage your doctor prescribed. If your prescription has any requirements, you'll get a coverage alert.

Look on a drug list.

Drug lists can't tell you the price of a prescription. But you can find out if step therapy is required.

Find your plan's drug lists.

Call us.

If you have questions about a prescription or step therapy during business hours, contact us and we'll help.