Step Therapy and Drug Costs: What You Need to Know

Step Therapy and Drug Costs: What You Need to Know


The rising cost of medication is a concern for everyone: patients, doctors, employers, insurance companies. As new drugs come into the market, it can be expensive for patients to have access to them. That’s why Blue Cross Blue Shield of Michigan and Blue Care Network are continuously developing new ways to help manage prescription costs and make treatments affordable and attainable for members.

That’s where step therapy comes in. It’s a way to make sure you get the safest, most effective and most reasonably priced medication available.

What is step therapy?

Step therapy is a program that guides your prescription drug coverage. The program starts you with less expensive drugs that have been proven effective for patients with similar conditions before taking a “step up” to a more expensive medication.

How does it work?

Your doctor prescribes you medicine and, typically, the prescription will be filled as written. But if the prescription is for a high-cost or new drug, Blue Cross may examine your medical history to ensure you’ve tried lower cost, established treatments first. If you haven’t, your prescription will start with those medications. If the suggested alternative drug does not relieve symptoms or help your condition, the more expensive drug can then be prescribed. This ensures that all approved, safe and cost-effective options have been tried before more expensive drugs are used, saving you money.

How will you know if your medicine requires step therapy?

Blue Cross’ pharmacy database will alert your pharmacist if the prescribed drug is eligible for step therapy. Your pharmacist will contact your doctor and your doctor will reconsider the prescription path. Your doctor may choose to explore alternative options or prescribe a medication that does not require step therapy.

Is step therapy safe?

Absolutely. Just because a medicine is more expensive, doesn’t necessarily mean it is more effective. A team of pharmacists and physicians routinely develop and review step therapy guidelines to ensure there’s a minimum risk for side effects and complications.

Want to learn more?

Read the updated guidelines for more information on step therapy and how it works at Blue Cross. And understand more about prescriptions and pharmaceuticals by checking out our member guide and these other blogs:

Photo credit: Tristan Schmurr