Step therapy definition

Step therapy means a program for Insureds who take Prescription Drugs for an ongoing medical condition, such as arthritis, asthma or high blood pressure, which ensures the Insured receives the most appropriate and cost-effective drug therapy for their condition. The Step Therapy program requires that before benefits are payable for a high cost Covered Drug that may have initially been prescribed, the Insured try a lower cost first-step Covered Drug. If the prescribing Physician has documented with SHL why the Insured’s condition cannot be stabilized with the first-step Covered Drug, SHL will review a request for Prior Authorization to move the Insured to a second-step drug, and so on, until it is determined by SHL that the prescribed Covered Drug is Medically Necessary and eligible for benefit payment.
Step therapy means a protocol or
Step therapy means a process that establishes a required order of use for a specific Prescription Medication. For example, a Step Therapy may require that medication “X” be used for a period of time before medication “Y” or that a weaker strength of a medication be used for a period before a stronger strength of the same medication.

Examples of Step therapy in a sentence

  • Transition eligible Step therapy, Prior Authorization and non-safety quantity limit edits are resolved at POS.


More Definitions of Step therapy

Step therapy means a type of protocol that specifies the sequence in which different prescription drugs for a given medical condition are to be prescribed.
Step therapy means a protocol by a healthcare insurer
Step therapy means a utilization review protocol, policy or program in which an
Step therapy means a drug protocol in which a health care coverage plan will reimburse the cost of a prescribed drug only if the patient has first tried a specified drug or series of drugs.
Step therapy means a protocol that
Step therapy requires the use of one product before another can be obtained. For certain drugs a prior authorization may also be required to substantiate that continued use is medically necessary.
Step therapy means a type of protocol or program the health carrier utilizes that establishes a sequence of covered prescription drugs for a given medical condition.