Drugs Requiring Step Therapy

Step Therapy requires the trial and failure of one or more prerequisite drugs before the step therapy medication will be covered. Step therapy promotes the appropriate use of equally effective but lower cost drugs, most often generics, as first line therapy.

Drugs Requiring Step Therapy	Step Therapy Policies	To Initiate a Coverage Review
Angiotensin II Receptor Blockers (ARBs)	Angiotensin II Receptor Blockers (ARBs)	Visit www.medco.com/coverage or call 1-800-753-2851
Migraine Medications	Migraine Medications	Visit www.medco.com/coverage or call 1-800-753-2851
Nasal Steroids	Nasal Steroids	Visit www.medco.com/coverage or call 1-800-753-2851
Non-Sedating Antihistamines	Non-Sedating Antihistamines	Visit www.medco.com/coverage or call 1-800-753-2851
Osteoporosis medications	Actonel Actonel with Calcium Forteo Fosamax Plus D	Visit www.medco.com/coverage or call 1-800-753-2851
Proton Pump Inhibitors	Aciphex Dexilant Prevacid (Brand Only) Prilosec (Brand Only) Protonix (Brand Only) Zegerid	Visit www.medco.com/coverage or call 1-800-753-2851
Selective Serotonin Reuptake Inhibitors (SSRIs)	Selective Serotonin Reuptake Inhibitors (SSRIs)	Visit www.medco.com/coverage or call 1-800-753-2851
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)	Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)	Visit www.medco.com/coverage or call 1-800-753-2851

Provider Instructions

To initiate and/or complete prior authorizations (coverage reviews) with Medco, prescribers have several options available. First, prescribers with a Personal Identification Number (PIN) and password can log on to Medco's prescriber coverage review website (www.medco.com/coverage) to view existing coverage review cases for their patients, initiate a coverage review case for their patients (a rejected pharmacy claim must be on file in order to initiate a case), or complete a coverage review case (answer the coverage criteria questions required to determine coverage).

If a prescriber does not have, or does not know their PIN and password, please call Medco at 1-800-496-5661, 8:00am to 9:00pm, eastern time, Monday thru Friday, and a PIN and password will be provided.

Another option to initiate and/or complete a coverage review case is to contact Medco's coverage review department at 1-800-753-2851, twenty-four hours a day, seven days a week.