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Step Therapy
Step Therapy is a process whereby prescriptions are fil ed with an effective, but more affordable
medication (Step 1). When appropriate, a more costly (Step 2) medication can be authorized if the
Step 1 prescription is not effective in treating your condition.
Step Therapy is used to help control Medicare Part D plan costs without jeopardizing the health of
CareSource members.
To see if one or more of the drugs you are taking requires Step Therapy, type the name of the drug
in the Search box below.
ANTI-INFLAMMATORY AGENTS - GI
Drug Name:
ASACOL HD, DIPENTUM
Step Therapy Criteria: PRIOR CLAIM FOR BALSALAZIDE OR APRISO WITHIN THE PAST 120
ANTIDIABETIC AGENTS - INSULINS
Drug Name:
LEVEMIR, LEVEMIR FLEXPEN
Step Therapy Criteria: PRIOR CLAIM FOR INSULIN GLARGINE (LANTUS OR LANTUS SOLOSTAR)
ANTIDIABETIC AGENTS - MISCELLANEOUS
Drug Name:
INVOKANA
Step Therapy Criteria: “PRIOR CLAIM FOR METFORMIN, METFORMIN ER, A SULFONYLUREA,
A COMBINATION OF SULFONYLUREA AND METFORMIN, PIOGLITAZONE, OR COMBINATION PIOGLITAZONE AND METFORMIN IN THE LAST 120 DAYS.” BUDESONIDE - UCERIS
Drug Name:
UCERIS
Step Therapy Criteria: PRIOR CLAIM FOR BALSALAZIDE WITHIN THE PAST 120 DAYS.
BUDESONIDE-FORMOTEROL FUMARATE
Drug Name:
SYMBICORT
Step Therapy Criteria: PRIOR CLAIM FOR ADVAIR OR DULERA WITHIN THE PAST 120 DAYS.
COPD
Drug Name:
DALIRESP
Step Therapy Criteria: “PRIOR CLAIM FOR ONE COPD AGENT (LAMA, LABA, SAMA, SAMA/
SABA) SUCH AS ATROVENT, COMBIVENT, SPIRIVA, ARCAPTA, SEREVENT, OR FORADIL WITHIN THE LAST 120 DAYS.” GAPABENTIN SR
Drug Name:
GRALISE
Step Therapy Criteria: PRIOR CLAIM FOR GABAPENTIN IMMEDIATE RELEASE WITHIN THE PAST
GLP-1 ANALOGS
Drug Name:
BYDUREON, BYETTA
Step Therapy Criteria: “PRIOR CLAIM FOR EITHER METFORMIN, METFORMIN ER, A SULFONYL-
UREA AGENT (E.G. GLYBURIDE, GLIPIZIDE), COMBINATION OF A SULFONYLUREA AND MET-FORMIN, A THIAZOLIDINEDIONE (E.G. PIOGLITAZONE, ROSIGLITAZONE), OR A COMBINATION THIAZOLIDINEDIONE AND METFORMIN WITHIN WITHIN THE PAST 120 DAYS.” HYPERURICEMIC AGENTS
Drug Name:
ULORIC
Step Therapy Criteria: PRIOR CLAIM FOR ALLOPURINOL OR COLCHICINE WITHIN THE PAST 120
KETOLIDES
Drug Name:
KETEK
Step Therapy Criteria: PRIOR CLAIM FOR A MACROLIDE WITHIN THE PAST 120 DAYS.
MULTIPLE SCLEROSIS AGENTS
Drug Name:
AVONEX, AVONEX ADMINISTRATION PACK, BETASERON, EXTAVIA
Step Therapy Criteria: PRIOR CLAIM FOR REBIF (INTERFERON BETA-1A) OR COPAXONE (GLATI-
RAMIR ACETATE) WITHIN THE PAST 120 DAYS.
“NSAIDS, CYCLOOXYGENASE INHIBITOR-TYPE”
Drug Name:
CELEBREX
Step Therapy Criteria: PRIOR CLAIM FOR ONE (1) NON-STEROIDAL ANTI-INFLAMMATORY
OPHTHALMIC ANTIHISTAMINES
Drug Name:
BEPREVE, PATADAY, PATANOL
Step Therapy Criteria: “PRIOR CLAIM FOR OTC LORATADINE, LORATADINE D, CETIRIZINE, CETI-
RIZINE D, OR GENERIC KETOTIFEN EYE DROPS (ALAWAY) OR LEVOCETIRIZINE OR CROMOLYN SODIUM EYE DROPS WITHIN THE PAST 120 DAYS.” RIFAXIMIN
Drug Name:
XIFAXAN
Step Therapy Criteria: PRIOR CLAIM FOR LACTULOSE WITHIN THE PAST 120 DAYS.
ROTIGOTINE
Drug Name:
NEUPRO
Step Therapy Criteria: PRIOR CLAIM FOR IMMEDIATE RELEASE PRAMIPEXOLE OR IMMEDIATE
RELEASE ROPINIROLE WITHIN THE PAST 120 DAYS.

Source: http://www.caresourcehealthplan.com/files/1913/8395/2671/January_2014_Plus_Rx_ST-web.pdf

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