What's Step Therapy and How Does It Work? 

At Blue Cross Blue Shield of Michigan, we believe in finding effective and low-cost medications for our members. That's why we use step therapy. 

What's step therapy?

Step therapy is trying certain medications before trying another drug for your condition. 

How step therapy works

  • It starts with your doctor prescribing a generic drug.
  • If the generic drug doesn't give you the results you need, your doctor may prescribe a different medication.
  • If the second medication doesn't work, your doctor may suggest another option. 

We'll check to see if you've tried two drug options before approving another medication. 

If you don't follow the procedure for step therapy, the drug may cost you more, or may not be covered at all. 

What if my prescription requires step therapy?

  • Talk with your doctor. They may be able to prescribe another medication that doesn't need step therapy. 
  • If there aren't other options for your condition, call the number on the back of your Blue Cross member ID card to start the approval process.
  • You can also start the approval process by completing the coverage determination form

How do I know if a prescription requires step therapy? 

You can learn how to read a drug list, but generally your pharmacist will tell you if a drug may need step therapy. 

Still need help?

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Related forms and documents

Request for Medicare Prescription Drug Coverage Determination (PDF)
Send us this completed form to request we make an exception for your drug.
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