Step therapy is a type of prior authorization. With step therapy, in most cases, you must first try certain less expensive drugs that have been proven effective for most people with your condition. For instance, some plans may require you to first try a generic prescription drug (if available), then a less expensive brand-name prescription drug on their drug list, before you can get a similar, more expensive brand-name prescription drug covered.

However, if you have already tried the similar, less expensive drugs and they didn’t work, or if your doctor believes that your medical condition makes it medically necessary for you to be on the more expensive step-therapy prescription drug, he or she can contact the plan to request an exception. If your doctor’s request is approved, the step-therapy prescription drug will be covered.