The goal of a Step Therapy Program is to steer people to less expensive, yet equally effective, prescription medications while keeping member and physician disruption to a minimum.
You must typically try a generic or preferred-brand medication before “stepping up” to a non-preferred brand.
For example, if you have allergy problems, you’ve likely tried over-the-counter medications. If they didn’t help, you could go to your doctor and get a prescription. With step therapy, your medication will be a less expensive option such as a generic medication. If that doesn’t work for you, your insurance will review the situation and potentially move you to a higher-tier, more expensive drug.
You can talk to your doctor or your insurance provider to see what drugs are covered for you, and the different prices for tiers of drugs.
Content by Lockton Dunning Benefits with info from: https://www.bcbsm.com/index/health-insurance-help/faqs/plan-types/pharmacy/what-is-step-therapy.html