Prescription Drugs
Step Therapy
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.
About Step Therapy
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. 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.
Here’s How it Works:
- 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.
Drugs subject to Step Therapy are marked with an “ST” code in our print and online formularies, which you can view here.
Part D Step Therapies
You can find 2024 Part D Step Therapy drugs at the following links:
Click here to view 2023 Part D Step Therapy requirements.
Part B Step Therapies
Part B drugs subject to Step Therapy are reflected in the Part B Step Therapy list only.
Click here to view the 2024 Part B Step Therapy list.
Click here to view the 2023 Part B Step Therapy list.