Step therapy is all about taking one “step” at a time when determining which treatment or medicine works best for you. Blue KC may recommend that you first try medicine A based on the latest medical literature and research. If medicine A doesn’t work as expected, then you can try medicine B, then medicine C, if necessary. This works similarly for treatments where we may require physical therapy before moving forward with a surgical procedure, for example. Step therapy helps you avoid spending money on more expensive care when a proven, more cost-effective alternative exists.
Already tried a required medication? Here’s what to do:
If you have already tried a medication that Blue KC is requiring you to take as part of the step therapy program, your doctor can request an exception to the rules and limitations by submitting an online prior authorization request that includes supporting documentation. We also provide a form for members to submit these requests but recommend your doctor complete this step because they have your full set of medical records that allow us to complete a fair and thorough review.