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The prior authorization/step therapy program is designed to encourage safe, cost-effective medication use.
This program may be part of your prescription drug benefit plan. To find out if your specific benefit plan includes the prior authorization/step therapy program, and which drug categories listed below are part of your plan, refer to your benefit booklet or call the Pharmacy Program number on the back of your ID card.
Prior Authorization
Under this part of the program, your physician will be required to obtain authorization from Blue Cross and Blue Shield of Illinois (BCBSIL) in order for you to receive benefits for certain medications and drug categories.
Examples of drug categories and specific medications* for which a prior authorization program may be included as part of your prescription drug benefit plan are listed below. Refer to your benefit booklet for information about your specific plan. Please note that the drug categories and medications may change from time-to-time. For the most up-to-date list, call the Pharmacy Program number on the back of your BCBSIL ID card.
As always, cost is only one factor in choosing medication, and treatment decisions are between you and your doctor.
Anabolic steroids
- Anadrol
- Oxandrin
- Winstrol
Growth Hormones
- Genotropin
- Gerif Diagnostic
- Humatrope
- Norditropin
- Nutropin
- Nutropin AQ
- Saizen
Hepatitis C
- Copegus
- Peg-Intron
- Pegasys
Oral Fentanyls
Step Therapy
Step therapy is a type of prior authorization. In order for you to receive coverage for drugs included in this part of the program, your physician will be required to obtain authorization from BCBSIL.
As an alternative to asking your doctor to receive prior authorization, or paying the entire cost of your medication out-of-pocket, you and your doctor may decide that a lower-cost generic or brand alternative medication that is not part of the program is right for you. Your plan will provide benefits for medications included in the program when you first try a lower-cost medication or your doctor obtains prior authorization of coverage through BCBSIL.
Examples of drug categories and specific medications* for which a step therapy program may be included as part of your prescription drug benefit plan are listed below. Step therapy does not apply to the generic equivalents for these medications (if available). If you and your doctor decide the generic equivalent is an option for you, you will not need to go through the prior authorization process. Please note: These medications are listed along with the first use approved by the U.S. Food and Drug Administration, but may be prescribed for conditions other than those noted and would still be part of the step therapy program.
Refer to your benefit booklet for information about your specific plan. Please note that the drug categories and medications may change from time-to-time. For the most up-to-date list, call the Pharmacy Program number on the back of your BCBSIL ID card.
As always, cost is only one factor in choosing medication, and treatment decisions are between you and your doctor.
Depression
Selective Serotonin Reuptake Inhibitors
- Celexa
- Lexapro
- Paxil
- Paxil CR
- Pexeva
- Prozac
- Zoloft
Selective Norepinephrine Reuptake Inhibitors
- Cymbalta
- Effexor
- Wellbutrin
- Wellbutrin SR
Epilepsy
- Gabitril
- Topamax
- Zonegran
Hypertension (High Blood Pressure)
| Angiotensin Converting Enzyme (ACE) Inhibitors |
| Aceon |
Lotensin HCT |
Univasc |
| Accupril |
Mavik |
Vaseretic |
| Accuretic |
Monopril |
Vasotec |
| Altace |
Monopril HCT |
Zestoretic |
| Capoten |
Prinivil |
Zestril |
| Capozide |
Prinzide |
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| Lotensin |
Uniretic |
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| Angiotensin Receptor Blockers (ARBs) |
| Atacand |
Benicar HCT |
Micardis |
| Atacand HCT |
Cozaar |
Micardis HCT |
| Avalide |
Diovan |
Teveten |
| Avapro |
Diovan HCT |
Teveten HCT |
| Benicar |
Hyzaar |
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Insomnia
- Ambien
- Ambien CR
- Lunesta
- Rozerem
- Sonata
Pain Relief
Psoriasis
Rheumatoid Arthritis
More information is available in the Prior Authorization Program Member Brochure and Step Therapy Program Member Brochure.
If you have questions about the prior authorization/step therapy program, call the Pharmacy Program number on the back of your BCBSIL ID card.
* Third-party brand names are the property of their respective owners.
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