Clearscript step therapy sheet

Step Therapy is a process that requires the use of one or more first line agents before a medication which is part of a step therapy protocol can be utilized. The goal of step therapy is to ensure that safe and cost effective medications are used based on recognized treatment guidelines and well documented clinical studies. This means that in some instances a patient will need to try one or more medications which are considered first line before they are able to receive a “second step” medication through your pharmacy benefit plan. Step therapy programs can be designed to be hard edits or soft therapy edits. Edits can be placed on a single drug or a class of drugs. Step-therapy edits can be utilized to require generic or lower cost products be utilized before higher cost products can be utilized. Pharmacies are notified instantane- ously at the point of sale the reason for denial and the appropriate course of action. These edits require a pharmacist’s intervention of the written prescription and dialogue with the physician to promote step therapy. PROGRAMS
CRITERIA
Diclofenac sodium, EC naproxen, Etodolac, Fenoprofen, Flurbiprofen, Diflunisal, Choline Magnesium, Salsalate, Ibuprofen, Indomethacin, Naproxen Sodium, Oxaprozin, Piroxicam, Sulindac, Tolmetin Glyburide, Glipizide, Glimepiride, Metformin, Metformin/Sulfonylurea Combination agent Glyburide, Glipizide, Glimepiride, Metformin, Metformin/Sulfonylurea Combination agent Benazepril, Captopril, Enalapril, Fosinopril, Benazepril HCT, Captopril HCT, Enalapril HCT, Fosinopril HCT, Lisinopril HCT, Quinapril HCT Teveten, Teveten HCT, Benicar, Benicar HCT Nexium, Prevacid, Generic OTC Zyrtec, OTC Claritin or Equivalents, Atrovent Inhaler, Combivent, Aminophyllin, Beclovent, Azmacort, Flovent, Qvar, Advair, Aerobid, Lufyllin, Ventolin, Proventil, Pulmicort PROGRAMS
CRITERIA
Benazepril, Enalapril, Captopril, Fosinopril, Diclofenac sodium, EC naproxen, Etodolac, Fenoprofen, Flurbiprofen, Diflunisal, Choline Magnesium, Salsalate, Ibuprofen, Indomethacin, Naproxen, Naproxen Sodium, Oxaprozin, Piroxicam, Sulindac, Tolmetin Paroxetine, Fluoxetine, Fluvoxamine, Citalopram , Paroxetine, Fluoxetine, Fluvoxamine, Citalopram, Aclometasone, triamcinolone, Capex, Clobex, Cloderm, Cordran, fluticasone, amcinonide, Derma-Smoothe/FS, Dermatop, betamethasone, desonide, mometasone, diflorasone, fluocinolone, Halog, hydrocortisone, Kenalog, fluocinonide, hydrocortisone, Luxiq, Olux, Pandel, Psorcon E, clobetasol, desoximetasone, halobetasol, Vanos *Indicates brand name medications with generic equivalents on the market. Step Therapy Protocols are reviewed by licensed clinical pharmacists and are intended to provide safe and cost-effective therapy to patients. These protocols are developed based on recognized treatment guidelines, side effect profiles, and cost. Any requests for alterations or customization of Step Therapy programs are subject to review by a clinical pharmacist prior to their implementation. 711 Kasota Ave. S.E.
Minneapolis, MN 55414612-672-6500

Source: http://www.clearscript.com/fv/groups/internet/documents/web_content/s_072060.pdf