Step therapy involves prescribing a safe, clinically effective and cost effective medication as the first step in treating a medical condition. The preferred medication is often a generic one that offers the best overall value in terms of safety, effectiveness and cost. Non-preferred drugs are only prescribed if the preferred medication is ineffective or poorly tolerated.
Drugs subject to step therapy will only be approved for first-time users after they have tried one of the preferred agents on the DoD uniform formulary (e.g., a patient must try omeprazole or Nexium® prior to using any other proton pump inhibitor).
Note: If a beneficiary filled a prescription for a step therapy drug within 180 days prior to step therapy implementation, the beneficiary will not be affected by step therapy requirements and will not be required to switch medications.