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.