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Step Therapy Criteria
Step Therapy Group
Drug Names
Step Therapy Criteria
PREVIOUS USE OF 30 DAYS OF TAMSULOSIN BEFORE UROXATRAL CAN BE Step Therapy Group
Drug Names
Step Therapy Criteria
PREVIOUS USE OF 30 DAYS OF FINASTERIDE BEFORE AVODART CAN BE Step Therapy Group
Drug Names
DETROL, DETROL LA, SANCTURA XR, TOLTERODINE TARTRATE, TROSPIUM Step Therapy Criteria
PREVIOUS USE OF 30 DAYS OF OXYBUTYNIN OR TROSPIUM.
Step Therapy Group
Drug Names
Step Therapy Criteria
PREVIOUS USE OF 30 DAYS OF WARFARIN HAS BEEN INEFFECTIVE, NOT TOLERATED OR IS CONTRAINDICATED BEFORE PRADAXA CAN BE APPROVED Step Therapy Group
Drug Names
BENICAR, BENICAR HCT, IRBESARTAN, IRBESARTAN/HYDROCHLOROTHI Step Therapy Criteria
PREVIOUS USE OF 30 DAYS OF A FORMULARY PREFERRED GENERIC ARB.
Step Therapy Group
Drug Names
Step Therapy Criteria
PREVIOUS USE OF 30 DAYS EACH OF TWO GENERIC BETA BLOCKERS BEFORE Step Therapy Group
Drug Names
Step Therapy Criteria
PREVIOUS USE OF 60 DAYS OF DORZOLAMIDE HAS BEEN INEFFECTIVE, NOT TOLERATED OR IS CONTRAINDICATED BEFORE AZOPT CAN BE APPROVED Step Therapy Group
Drug Names
Step Therapy Criteria
FOR DOSES LESS THAN 20 MG REQUIRE 60 DAY TRIAL OF AT LEAST ONE FORMULARY GENERIC STATIN: SIMVASTATIN, LOVASTATIN, PRAVASTATIN, OR Step Therapy Group
Drug Names
ACTOPLUS MET, ACTOPLUS MET XR, ACTOS, DUETACT, JANUMET, ONGLYZA, PIOGLITAZONE HCL, PIOGLITAZONE HCL-GLIMEPIR, PIOGLITAZONE Step Therapy Criteria
PREVIOUS USE OF 30 DAYS OF METFORMIN BEFORE OTHER ORAL DIABETIC Step Therapy Group
Drug Names
Step Therapy Criteria
PREVIOUS USE OF 30 DAYS EACH OF TWO FORMULARY GENERIC TOPICAL STEROIDS WITHIN THE PAST 180 DAYS HAS BEEN INEFFECTIVE, NOT TOLERATED OR IS CONTRAINDICATED BEFORE ELIDEL CAN BE APPROVED.
Step Therapy Group
Drug Names
Step Therapy Criteria
PREVIOUS USE OF 30 DAYS EACH OF TWO OF THE FOLLOWING GENERIC SSRIs BEFORE ESCITALOPRAM CAN BE APPROVED: CITALOPRAM, FLUOXETINE, FLUVOXAMINE, PAROXETINE, OR SERTRALINE.
Step Therapy Group
Drug Names
Step Therapy Criteria
PREVIOUS USE OF 30 DAYS EACH OF OMEPRAZOLE AND PANTOPRAZOLE HAVE BEEN INEFFECTIVE, NOT TOLERATED OR CONTRAINDICATED BEFORE Step Therapy Group
Drug Names
Step Therapy Criteria
PREVIOUS USE OF 60 DAYS OF GENERIC FENOFIBRATE BEFORE TRICOR CAN Step Therapy Group
Drug Names
FENTANYL, FENTANYL CITRATE ORAL TRA, MORPHINE SULFATE ER Step Therapy Criteria
PREVIOUS USE OF 7 DAYS OF METHADONE FIRST AND 7 DAYS OF MORPHINE SULFATE ER SECOND WERE INEFFECTIVE, NOT TOLERATED OR ARE CONTRAINDICATED BEFORE FENTANYL CAN BE APPROVED.
Step Therapy Group
Drug Names
Step Therapy Criteria
PREVIOUS USE OF 30 DAYS EACH OF ZOLPIDEM AND ZALEPLON BEFORE Step Therapy Group
Drug Names
ASMANEX 120 METERED DOSES, ASMANEX 14 METERED DOSES, ASMANEX 30 METERED DOSES, ASMANEX 60 METERED DOSES, FLOVENT DISKUS, Step Therapy Criteria
PREVIOUS USE OF 30 DAYS EACH OF QVAR FIRST AND PULMICORT SECOND BEFORE OTHER INHALED CORTICOSTEROIDS CAN BE APPROVED.
Step Therapy Group
Drug Names
Step Therapy Criteria
PREVIOUS USE OF AT LEAST 30 DAYS OF A GENERIC FORMULARY STIMULANT SUCH AS METHYLPHENIDATE, AMPHETAMINE- DEXTROAMPHETAMINE, OR Step Therapy Group
Drug Names
Step Therapy Criteria
PREVIOUS USE OF AT LEAST 30 DAYS OF GENERIC LEVETIRACETAM HAS BEEN INEFFECTIVE, NOT TOLERATED OR IS CONTRAINDICATED BEFORE Step Therapy Group
Drug Names
Step Therapy Criteria
PREVIOUS USE OF 7 DAYS OF METHADONE WAS INEFFECTIVE, NOT Step Therapy Group
Drug Names
Step Therapy Criteria
PREVIOUS USE OF 30 DAYS EACH OF TWO GENERIC PPIs HAVE BEEN INEFFECTIVE, NOT TOLERATED OR CONTRAINDICATED BEFORE OTHER PPIs Step Therapy Group
Drug Names
Step Therapy Criteria
PREVIOUS USE OF 30 DAYS OF VENLAFAXINE ER BEFORE OTHER SNRI CAN Step Therapy Group
Drug Names
Step Therapy Criteria
PREVIOUS USE OF 30 DAYS EACH OF TWO GENERIC SSRIs BEFORE OTHER Step Therapy Group
Drug Names
Step Therapy Criteria
PREVIOUS USE OF 30 DAYS OF DIVALPROEX, DIVALPROEX ER, OR VALPROIC ACID BEFORE STAVZOR CAN BE APPROVED.
Step Therapy Group
Drug Names
Step Therapy Criteria
PREVIOUS USE OF 30 DAYS EACH OF TWO GENERIC ANTICONVULSANTS INCLUDING CARBAMAZEPINE HAVE BEEN INEFFECTIVE, NOT TOLERATED OR CONTRAINDICATED BEFORE TEGRETOL XR CAN BE APPROVED Step Therapy Group
Drug Names
MAXALT, MAXALT-MLT, RELPAX, RIZATRIPTAN BENZOATE, RIZATRIPTAN Step Therapy Criteria
PREVIOUS USE OF A 10 DAY SUPPLY EACH OF SUMATRIPTAN AND NARATRIPTAN BEFORE BRAND NAME TRIPTANS CAN BE APPROVED.
Step Therapy Group
Drug Names
Step Therapy Criteria
PREVIOUS USE OF 30 DAYS OF LACTULOSE BEFORE XIFAXAN CAN BE Step Therapy Group
Drug Names
Step Therapy Criteria
PREVIOUS USE OF 10 DAYS OF AZITHROMYCIN, ERYTHROMYCIN, OR CLARITHROMYCIN WERE INEFFECTIVE, NOT TOLERATED OR IS CONTRAINDICATED BEFORE ZMAX CAN BE APPROVED

Source: http://www.familycareinc.org/images/uploads/entries/WEB_ST_November_2013.pdf