Quick Links
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 drugs are part of your plan, refer to your benefit materials, or call the number on the back of your ID card.
Prior Authorization
Under this program, your doctor will be required to request pre-approval, or prior authorization, through Blue Cross and Blue Shield of Oklahoma (BCBSOK) in order for you to get benefits for the select drugs.
- 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.
- Please note that not all drug categories are included in all benefit plans. Additional drug categories may be added and the medications listed are only examples. Call the number on the back of your ID card with questions about a specific medication.
- If you are taking, or prescribed, a drug that is newly introduced to the market on or after October 1, 2015, you may need to have your doctor submit a prior authorization request in order to get benefits for such drugs. If you have questions about your medicine, call the number on the back of your ID card.
- As always, cost is only one factor in choosing medication and treatment decisions are between you and your doctor.
- Prior Authorization Program for Members on a “Metallic” Health Plan
- Prior Authorization Program for Members on the Basic or Enhanced Drug Lists
- Prior Authorization Program for Members on the Balanced Drug List
- Prior Authorization Program for Members on the Performance Drug List
- Prior Authorization Program for Members on the Performance Select Drug List
- A first-line drug is recognized as safe and works well in treating a specific medical condition, as well as being a cost-effective treatment option.
- A second-line drug is a less-preferred or likely a more costly treatment option.
- Below are examples of drug categories and specific medications for which a step therapy program may be included as part of your prescription drug benefit plan.
- Step therapy does not apply to the generic equivalents for these medications (if available), so if you and your doctor decide the generic equivalent is best for you, prior authorization is not required.
- 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.
- Please note that not all drug categories are included in all benefit plans. Additional categories may be added and the medications listed are only examples. Call the number on the back of your ID card with questions about a specific medication.
- As always, cost is only one factor in choosing medication and treatment decisions are between you and your doctor.
- Step Therapy Programs for Members on a "Metallic" Health Plan
- Step Therapy Programs for Members on the Basic or Enhanced Drug Lists
- Step Therapy Programs for Members on the Balanced Drug List
- Step Therapy Programs for Members on the Performance Drug List
- Step Therapy Programs for Members on the Performance Select Drug List
Step Therapy
The step therapy program requires that you have prescription history for a "first-line" medication before your benefit plan will cover a "second-line" drug.
Step 1: If possible, your doctor should prescribe a first-line medication right for your condition.
Step 2: If you and your doctor decide that a first-line drug is not right for you or is not as good in treating your condition, your doctor should submit a prior authorization request for coverage of the other drug.
If you have questions about the prior authorization/step therapy program, call the number on the back of your BCBSOK ID card.
for more information.