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Other programs

Prior Authorization Program

What exactly is the Prior Authorization Program?

This program covers certain drugs that require special action by your physician before you can have a prescription for them filled through the Welfare Fund. These drugs all have [PA] next to them on the formulary list. For any of these “PA” drugs, your physician should call Medco/ESI and may be asked to mail or fax both a Letter of Medical Necessity and a diagnosis to Medco/ESI.

Step Therapy Program

What is Step Therapy?

This is a program that encourages the use of the best medication for your condition. It applies to first-time users of drugs in certain categories. Some examples of these categories include psychotropic, asthma, PPI (heartburn and ulcer), hypertension, and cholesterol.

Under this program, when you start on one of these medications you must first try a well-established treatment that is known to be safe and effective. This is called “first-line therapy,” and it is the preferred therapy for most people. It also usually has the lowest co-payment.

If your doctor has found the first-line drug has not been very successful for you, he or she may request a second-line therapy. However, no second-line therapy will be approved unless the first-line therapy has been tried.

How do I know which medications require Step Therapy?

All Preferred medications that have an indication of [STP] next to them on the formulary list will require Step Therapy.