Step therapy protocol simply means that a member may need to use one type of medication before another. Anthem Prescription has edits, which are simply electronically transmitted instructions to the pharmacist, patient, or physician, on some drugs to control utilization, to ensure that appropriate prescribing guidelines are followed, and to help members access high quality, yet cost-effective prescription drugs. Step Therapy, Prior Authorization and Quantity Limitation are three of the ways these goals are achieved.
A group of trained clinicians at Anthem Prescription continuously reviews new drugs and research studies. If a particular drug has a high potential to be over prescribed, or taken for non-FDA approved uses, a drug edit may be needed. In the case of Vioxx and Celebrex, it was found that these drugs should be reserved for patients who are at high risk for gastro-intestinal (GI) track bleeding or distress. Therefore, it may be prudent for a member to try, for instance, a regular non-steroidal anti-inflammatory drug (NSAID) (i.e. ibuprofen), which should be an equally effective medication.
Your physician will need to submit a letter or fax including the following details:
Requests may be addressed to:
Anthem Prescription Management
Customer Service Dept.
P.O. Box 746000
Cincinnati, OH 45274-6000 Fax: 800-600-4829
Note: Anthem health plans and many groups under those plans vary considerably in what clinical services and programs they apply. For instance, Maine will not apply step therapy protocols to plans in that state.