Step Therapy and Quantity Limits

Step Therapy

This requirement encourages you to try less costly but usually just as effective drugs before the plan covers another drug. For example, if Drug A and Drug B treat the same medical condition, the plan may require you to try Drug A first. If Drug A does not work for you, the plan will then cover Drug B. This requirement to try a different drug first is called “step therapy.”

Quantity Limits

For certain drugs, we limit the amount of the drug that you can have by limiting how much of a drug you can get each time you fill your prescription. For example, if it is normally considered safe to take only one pill per day for a certain drug, we may limit coverage for your prescription to no more than one pill per day.

You can find out if your drug has any additional requirements or limits by reviewing your Comprehensive Formulary. We have posted online documents that explain our prior authorization and step therapy restrictions. You may also ask us to send you a copy by contacting our Customer Care Center.

You can ask Banner Medicare Rx to make an exception to these restrictions or limits or for a list of other, similar drugs that may treat your health condition