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Blue Cross and Blue Shield of Minnesota Step Therapy

Blue Cross and Blue Shield of Minnesota Step Therapy 2025

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The document outlines the standardized step therapy program implemented by Blue Cross and Blue Shield of Minnesota, effective January 1, 2010. It details two formulary options, FlexRx and GenRx, which include various drug categories subject to step therapy requirements. The document explains how the step therapy process works, including prerequisites for medication approval and provides answers to common questions regarding the program. The initiative aims to promote cost-effective medication use while ensuring therapeutic safety and effectiveness.

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What is the meaning of step treatment?

Step therapy means trying less expensive options before stepping up to drugs that cost more. Heres an example of the step therapy process. Lets say youre having allergy problems. You should first try using an over-the-counter medication. If that doesnt help you, try a Tier 1 medicine.

What is BCBS step therapy?

What would be considered a step therapy exception?

The required prescription drug is contraindicated or is likely, or expected, to cause an adverse reaction or physical or mental harm to the enrollee in comparison to the requested prescription drug, based on the known clinical characteristics of the enrollee and the known characteristics and history of the enrollees

What does step therapy mean for Ozempic?

If a health plan uses step therapy for certain drugs, it means that a patient can be required to try a lower cost prescription drug that treats a given condition before stepping up to a similar-acting, but more expensive drug.

Is step therapy the same as prior authorization?

Essentially, step therapy is a type of prior authorization a restriction your insurance company puts in place to determine whether or not they will pay for certain medications.

What step therapy is required for Mounjaro?

Step therapy is a type of limit on prescription coverage. Insurance companies use it to control cost and prevent unnecessary medication use.

What does step therapy mean for insurance?

Many health insurance providers have a step therapy requirement for Mounjaro. For example, some plans may require you to try a generic type 2 diabetes drug, such as metformin, before it will cover Mounjaro (which is a brand-name drug). A generic contains an exact copy of the active drug in a brand-name medication.

Blue Cross and Blue Shield of Minnesota Step Therapy 2025

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