Prescription Drug Step Therapy

PROVIDERS: PAs may be submitted via the phone, (800) 313-7879 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 the list below for specific drugs and procedures requiring review.

Search listing by:

Drug Name: type brand name or generic name of drug in text box
Category: select a category from drop-down menu
Alphabetical Order: click on brand name drug or category column header

Last Update: 1-23-13

Brand Name Drug (Generic NAme)	Category	PDF(s)

Qnsal	Intranasal Corticosteroid	Guidelines Form
Intermezzo (zolpidem)	Hypnotic	Guidelines Form
Trajenta (linagliptin)	Diabetes Medications, Supplies & Test Strips	Guidelines Form
Silenor (doxepin)	Hypnotics	Guidelines Form
Livalo (Pitavastatin)	Cholesterol Lowering	Guidelines Form
Simcor	Cholesterol Lowering	Guidelines Form
Zolpimist	Hypnotics	Guidelines Form
Kombiglyze	Diabetes Medications, Supplies & Test Strips	Guidelines Form
Luvox (fluvoxamine)	SSRIs	Guidelines Form
Advicor (lovastatin / niacin)	Cholesterol Lowering	Guidelines Form
Altoprev (lovastatin extended release)	Cholesterol Lowering	Guidelines Form
Caduet (atovastatin / amlodipine)	Cholesterol Lowering	Guidelines Form
Vytorin (simvastatin / ezetimibe)	Cholesterol Lowering	Guidelines Form
Zetia (ezetimibe)	Cholesterol Lowering	Guidelines Form
Famvir (famcyclovir)	Antiviral	Guidelines Form
Valtrex (valacyclovir)	Antiviral	Guidelines Form
Singulair (montelukast)	Leukotrienes	Guidelines Form
Accolate (zafirlukast)	Leukotrienes	Guidelines Form
Zylfo, Zylfo CR (zileuton)	Leukotrienes	Guidelines Form
Intuniv (guanfacine)	Attention Deficit Hyperactivity Disorder	Guidelines Form
Strattera (atomoxetine)	Attention Deficit Hyperactivity Disorder	Guidelines Form
Aciphex (rabeprazole sodium)	Proton Pump Inhibitors	Guidelines Form
Nexium (esomeprazole)	Proton Pump Inhibitors	Guidelines Form
Dexilant (dexlansoprazole)	Proton Pump Inhibitors	Guidelines Form
Viibryd (Vilazodone)	SSRIs	Guidelines Form
Pristiq (desvenlafaxine)	SSRIs	Guidelines Form
Prozac Weekly (fluoxetine)	SSRIs	Guidelines Form
Clarinex (desloratadine)	Non Sedating Anti Histamines	Guidelines Form
Xyzal (levocetirizine)	Non Sedating Anti Histamines	Guidelines Form
Celebrex (celecoxib)	COX-2 Inhibitors	Guidelines Form
Antara (fenofibrate)	Fenofibrates	Guidelines Form
Fenoglide (fenofibrate)	Fenofibrates	Guidelines Form
Fibricor (fenofibrate acid)	Fenofibrates	Guidelines Form
Lipofen (fenofibrate capsules)	Fenofibrates	Guidelines Form
Lofibra (fenofibrate capsules micronized)	Fenofibrates	Guidelines Form
Lovaza (omega-3 fatty acid)	Fenofibrates	Guidelines Form
Triglide (fenofibrate)	Fenofibrates	Guidelines Form
Trilipix (fenofibrate acid)	Fenofibrates	Guidelines Form
Detrol (tolterodine)	Overactive Bladder	Guidelines Form
Detrol LA (tolterodine)	Overactive Bladder	Guidelines Form
Enablex (darifenacin)	Overactive Bladder	Guidelines Form
Gelnique (transdermal oxybutynin)	Overactive Bladder	Guidelines Form
Sanctura (trospium)	Overactive Bladder	Guidelines Form
Sanctura XR (trospium)	Overactive Bladder	Guidelines Form
Toviaz (fesoterodine)	Overactive Bladder	Guidelines Form
Vesicare (solifenacin)	Overactive Bladder	Guidelines Form
Amturnide (amlodipine/aliskiren/hydrochlorothiazide)	Angiotensin Receptor Blockers	Guidelines Form
Azor (n/a)	Angiotensin Receptor Blockers	Guidelines Form
Benicar (olmesartan medoxomil)	Angiotensin Receptor Blockers	Guidelines Form
Benicar HCT (olmesartan medoxomil with hydrochlorothiazide)	Angiotensin Receptor Blockers	Guidelines Form
Exforge (amlopipine and valsartan)	Angiotensin Receptor Blockers	Guidelines Form
Exforge HCT (amlopipine /valsartan /hydrochlorothiazide)	Angiotensin Receptor Blockers	Guidelines Form
Edarbi (azilsartan medoxomil)	Angiotensin Receptor Blockers	Guidelines Form
Edarbychlor (azilsartan medoxomil and chlorthalidone)	Angiotensin Receptor Blockers	Guidelines Form
Micardis (telmisartan)	Angiotensin Receptor Blockers	Guidelines Form
Micardis HCT (telmisartan with hydrochlorothiazide)	Angiotensin Receptor Blockers	Guidelines Form
Tekamlo (aliskiren/amlodipine)	Angiotensin Receptor Blockers	Guidelines Form
Teveten (eprosartan mesylate)	Angiotensin Receptor Blockers	Guidelines Form
Teveten HCT (eprosartan mesylate with hydrochlorothizide)	Angiotensin Receptor Blockers	Guidelines Form
Tekturna (aliskiren)	Angiotensin Receptor Blockers	Guidelines Form
Tekturna HCT (aliskiren-HCTZ)	Angiotensin Receptor Blockers	Guidelines Form
Twynsta (telmisartan/amlodipine)	Angiotensin Receptor Blockers	Guidelines Form
Valturna (aliskiren and valsartan)	Angiotensin Receptor Blockers	Guidelines Form
Lunesta (eszopiclone)	Hypnotics	Guidelines Form
Rozerem (ramelteon)	Hypnotics	Guidelines Form
Beconase AQ (beclomethasone nasal)	Intranasal Corticosteroids	Guidelines Form
Nasacort AQ (triamcinolone acetonide)	Intranasal Corticosteroids	Guidelines Form
Omnaris (ciclesonide)	Intranasal Corticosteroids	Guidelines Form
Rhinocort Aqua (budesonide nasal)	Intranasal Corticosteroids	Guidlines Form
Veramyst (bluticasone furoate)	Intranasal Corticosteroids	Guidelines Form
Amerge (naratriptan)	Migraine/Triptans	Guidelines Form
Axert (almotriptan malate)	Migraine/Triptans	Guidelines Form
Frova (frovatriptan succinate)	Migraine/Triptans	Guidelines Form
Relpax (eletriptan hydrobromide)	Migraine/Triptans	Guidelines Form
Treximet (sumatriptan & naproxen)	Migraine/Triptans	Guidelines Form
Zomig (zolmitriptan)	Migraine/Triptans	Guidelines Form
Bystolic (nebivolol)	Beta Blockers	Guidelines Form
Actonel (risedronate sodium)	Osteoporosis Bisphosphonates	Guidelines Form
Actonel with Calcium (risedronate sodium with calcium)	Osteoporosis Bisphosphonates	Guidelines Form
Boniva (ibandronate sodium)	Osteoporosis Bisphosphonates	Guidelines Form
Fosamax D (alendronate sodium)	Osteoporosis Bisphosphonates	Guidelines Form
Avodart (dutasteride)	Benign Prostatic Hypertrophy BPH	Guidelines Form
Lyrica (pregabalin)	Neuropathic Pain	Guidelines Form
Actos (pioglitazone)	Diabetes Medications, Supplies & Test Strips	Guidelines Form
Actoplus Met (pioglitazone & metformin)	Diabetes Medications, Supplies & Test Strips	Guidelines Form
Avandamet (rosiglitazone & metformin)	Diabetes Medications, Supplies & Test Strips	Guidelines Form
Avandaryl (rosiglitazone & glimepiride)	Diabetes Medications, Supplies & Test Strips	Guidelines Form
Avandia (rosiglitazone)	Diabetes Medications, Supplies & Test Strips	Guidelines Form
Bayer Ascencia Elite & Autodisc/Breeze /Contour (n/a)	Diabetes Medications, Supplies & Test Strips	Guidelines Form
Blood Glucose Test Strips (n/a)	Diabetes Medications, Supplies & Test Strips	Guidelines Form
Byetta (exenatide)	Diabetes Medications, Supplies & Test Strips	Guidelines Form
Bydureon (exenatide extended-release)	Diabetes Medications, Supplies & Test Strips	Guidelines Form
Duetact (pioglitazone & glimepiride)	Diabetes Medications, Supplies & Test Strips	Guidelines Form
Janumet (sitagliptin & metformin)	Diabetes Medications, Supplies & Test Strips	Guidelines Form
Januvia (sitagliptin)	Diabetes Medications, Supplies & Test Strips	Guidelines Form
Onglyza (saxagliptin)	Diabetes Medications, Supplies & Test Strips	Guidelines Form
Prestige (n/a)	Diabetes Medications, Supplies & Test Strips	Guidelines Form
Roche Accuchek Compact / Active / Advantage / Aviva / Comfort Curve / Compact (n/a)	Diabetes Medications, Supplies & Test Strips	Guidelines Form
Surestep (n/a)	Diabetes Medications, Supplies & Test Strips	Guidelines Form
Truetrack (n/a)	Diabetes Medications, Supplies & Test Strips	Guidelines Form
Victoza (liraglutide)	Diabetes Medications, Supplies & Test Strips	Guidelines Form
Advair (fluticasone & salmeterol)	Asthma & COPD	Guidelines Form
Symbicort (budesonide & formoterol)	Asthma & COPD	Guidelines Form