Prescription Drug Step Therapy

NOTE:  Effective 5/1/2010 there is only one Step Therapy listing for all members.  

PROVIDERS: PAs may be submitted via the phone, 800-313-78979 or online, https://ExpressPA.pahub.com.

Our Step Therapy Program saves members money by encouraging their doctors to try less expensive drugs before using the newest, most expensive ones.

Check this list for the specific drugs and procedures for review.  

Last Update: 05/05/2010

Statins	GENERIC Name	guidelines & form
Advicor	lovastatin / niacin	Advicor Guidelines Advicor PA Form
Altoprev	lovastatin extended release	Altoprev Guidelines Altoprev PA Form
Caduet	atovastatin / amlodipine	Caduet Guidelines Caduet PA Form
Lipitor ONLY 10 mg & 20 mg	atovastatin	Lipitor (10 & 20 mg ONLY) Guidelines Lipitor (10 & 20 mg ONLY) PA Form
Vytorin	simvastatin / ezetimibe	Vytorin Guidelines Vytorin PA Form
Antiviral	GENERIC Name	guidelines & form
Famvir	famcyclovir	Famvir Guidelines Famvir PA Form
Valtrex	valacyclovir	Valtrex Guidelines Valtrex PA Form
SSRIs	GENERIC NAME	guidelines & form
Cymbalta	duloxetine	Cymbalta Guidelines Cymbalta PA Form
Effexor XR	venlafaxine	Effexor XR Guidelines Effexor XR PA Form
Lexapro	escitalopram oxalate	Lexapro Guidelines Lexapro PA Form
Pristiq	desvenlafaxine	Pristiq Guidelines Pristiq PA Form
Prozac Weekly	fluoxetine	Prozac Weekly Guidelines Prozac Weekly PA Form
Non Sedating Anti Histamines	generic Name	Guidelines & form
Allegra	fexofenadine Hcl	Allegra Guidelines Allegra PA Form
Clarinex	desloratadine	Clarinex Guidelines Clarinex PA Form
Xyzal	levocetirizine	Xyzal Guidelines Xyzal PA Form
Zyrtec	cetirizine	Zyrtec Guidelines Zyrtec PA Form
COX-2 Inhibitors	generic Name	Guidelines & form
Celebrex	celecoxib	Celebrex Guidelines Celebrex PA Form
Proton Pump Inhibitors	generic Name	Guidelines & form
Aciphex	rabeprazole sodium	Aciphex Guidelines Aciphex PA Form
Nexium	esomeprazole	Nexium Guidelines Nexium PA Form
Kapidex	dexlansoprazole	Kapidex Guidelines Kapidex PA Form
Pantoprazole	n/a	Pantoprazole Guidelines Pantoprazole PA Form
Prevacid	lanxoprazole	Prevacid Guidelines Prevacid PA Form
Prilosec	omeprazole	Prilosec Guidelines Prilosec PA Form
Protonix	pantoprazole	Protonix Guidelines Protonix PA Form
Zegerid	omeprazole	Zegerid Guidelines Zegerid PA Form
Angiotensin Receptor Blockers	generic Name	Guidelines & form
Atacand	candesartan cilexetil	Atacand Guidelines Atacand PA Form
Atacand HCT	candesartan cilexetil with hydrochlorothiazide	Atacand HCT Guidelines Atacand HCT PA Form
Avalide	irbesartan with hydrochlorothiazide	Avalide Guidelines Avalide PA Form
Avapro	irbesartan	Avapro Guidelines Avapro PA Form
Azor		Azor Guidelines Azor PA Form
Benicar	olmesartan medoxomil	Benicar Guidelines Benicar PA Form
Benicar HCT	olmesartan medoxomil with hydrochlorothiazide	Benicar HCT Guidelines Benicar HCT PA Form
Cozaar	losartan	Cozaar Guidelines Cozaar PA Form
Diovan	valsartan	Diovan Guidelines Diovan PA Form
Diovan HCT	valsartan with hydrochlorothiazide	Diovan HCT Guidelines Diovan HCT PA Form
Exforge	amlopipine and valsartan	Exforge Guidelines Exforge PA Form
Hyzaar	losartan	Hyzaar Guidelines Hyzaar PA Form
Micardis	telmisartan	Micardis Guidelines Micardis PA Form
Micardis HCT	telmisartan with hydrochlorothiazide	Micardis HCT Guidelines Micardis HCT PA Form
Teveten	eprosartan mesylate	Teveten Guidelines Teveten PA Form
Teveten HCT	eprosartan mesylate with hydrochlorothizide	Teveten HCT Guidelines Teveten HCT PA Form
Hypnotics	GENERIC name	guidelines & form
Ambien CR	zolpidem tartarate extended release	Ambien CR Guidelines Ambien PA Form
Lunesta	eszopiclone	Lunesta Guidelines Lunesta Form
Rozerem	ramelteon	Rozerem Guidelines Rozerem Form
Intranasal Corticosteroids	GENERIC name	guidelines & form
Beconase AQ	beclomethasone nasal	Beconase AQ Guidelines Beconase AQ Form
Nasacort AQ	triamcinolone acetonide	Nasacort AQ Nasacort AQ Form
Omnaris	ciclesonide	Omnaris Guidelines Omnaris PA Form
Rhinocort Aqua	budesonide nasal	Rhinocort Aqua Guidlines Rhinocort Aqua Form
Veramyst	bluticasone furoate	Veramyst Guidelines Veramyst Form
Migraine/Triptans	GENERIC name	guidelines & form
Amerge	naratriptan	Amerge Guidelines Amerge Form
Axert	almotriptan malate	Axert Guidelines Axert Form
Frova	frovatriptan succinate	Frova Guidelines Frova Form
Relpax	eletriptan hydrobromide	Relpax Guidelines Relpax Form
Treximet	sumatriptan & naproxen	Treximet Guidelines Treximet Form
Zomig	zolmitriptan	Zomig Guidelines Zomig Form
Beta Blockers	GENERIC Name	guidelines & form
Bystolic	nebivolol	Bystolic Guidelines Bystolic Form
Coreg CR	carvedilol	Coreg Guidelines Coreg Form
Osteoporosis Bisphosphonates	GENERIC Name	guidelines & form
Actonel	risedronate sodium	Actonel Guidelines Actonel Form
Actonel with Calcium	risedronate sodium with calcium	Actonel with Calcium Guidelines Actonel with Calcium Form
Boniva	ibandronate sodium	Boniva Guidelines Boniva Form
Fosamax D	alendronate sodium	Fosamax D Guidelines Fosamax D Form
Benign Prostatic Hypertrophy BPH	GENERIC name	guidelines & form
Avodart	dutasteride	Avodart Guidelines Avodart Form
Neuropathic Pain	GENERIC name	guidelines & form
Lyrica	pregabalin	Lyrica Guidelines Lyrica Form
DIABETES MEDICATIONS & SUPPLIES	GENERIC name	guidelines & form
Actos	pioglitazone	Actos Guidelines Actos Form
Actoplus Met	pioglitazone & metformin	Actoplus Met Guidelines Actoplus Met Form
Avandamet	rosiglitazone & metformin	Avandamet Guidelines Avandamet Form
Avandaryl	rosiglitazone & glimepiride	Avandaryl Guidelines Avandaryl Form
Avandia	rosiglitazone	Avandia Guidelines Avandia Form
Bayer (Ascencia Elite & Autodisc/Breeze /Contour)	n/a	Bayer Guidelines Bayer Form
B-D	n/a	B-D Guidelines B-D Form
Byetta	exenatide	Byetta Guidelines Byetta Form
Duetact	pioglitazone & glimepiride	Duetact Guidelines Duetact Form
Janument	sitagliptin & metformin	Janument Guidelines Janument Form
Januvia	sitagliptin	Januvia Guidelines Januvia Form
Onglyza	saxagliptin	Onglyza Guidelines Onglyza Form
Prestige	n/a	Prestige Guidelines Prestige Form
Roche Accuchek (Compact)	n/a	Roche Accuchek Guidelines Roche Accuchek Form
Surestep	n/a	Surestep Guidelines Surestep Form
Truetrack	n/a	Truetrack Guidelines Truetrack Form
Victoza	liraglutide	Victoza Guidelines Victoza Form
AsThMA & COPD	GENERIC name	guidelines & form
Advair	fluticasone & salmeterol	Advair Guidelines Advair Form
Symbicort	budesonide & formoterol	Symbicort Guidelines Symbicort Form