Our drug formulary (drug listing) is reviewed each month. Medications are listed by copay tier, with lower tiers associated with lower cost share. We make regular changes to include new generic products and modify restrictions. Here’s an updated list of associated restrictions and limitations:
Step therapy is a formulary (drug listing) tool used to manage high-cost medications while improving health. When a medication requires step therapy, you're encouraged to try a less costly, clinically equivalent drug first. After trying this therapy, you can work with your prescriber to decide what's best for you.
You and your prescriber may find that the lower cost medication works well. If the medication isn’t working, or your need is medically necessary, ask your prescriber to contact Navitus.
Step therapy is an effective tool for ensuring that you receive safe, effective, high-quality medications at a lower cost.
Navitus uses a pharmacy & therapeutics (P&T) committee to make all drug therapy decisions, including step therapy. They evaluate the safety and efficacy of a product, including clinical practice guidelines, based on available medical literature.
The committee considers cost only after it makes the clinical determination. Once the medication is evaluated, if a lower cost alternative exists, a step therapy protocol is set up.