Step Therapy is a type of coverage determination that applies to certain drugs. When Step Therapy applies, we require you to try certain drugs to treat your medical condition first before we will cover another drug for that condition.
As a Jefferson Health Plans member, you have the right to appeal a decision we’ve made about your coverage or submit a formal complaint.
If you’re facing an issue with Jefferson Health Plans, please contact Member Relations at 1-866-901-8000 (TTY 1-877-454-8477) and we will work to resolve the issue.
For example:
If Drug A and Drug B both treat your medical condition, Jefferson Health Plans Medicare may not cover Drug B unless you try Drug A first. If Drug A does not work for you, Jefferson Health Plans will then cover Drug B.
Prescription drugs subject to Step Therapy are marked with an “ST” code in our print and online formularies, which you can view here.
Part B Preferred Drugs
Part B drugs are subject to Step Therapy. Our guidelines are reflected in the Part B Step Therapy list below:
2026 Part B Step Therapy Preferred Drug List (effective January 1, 2026)