1. Maintenance Drug C Prescribed Maintenance Drug A Prescribed
90 Day Maintenance Fill
Without Step Therapy
With Step Therapy
Maintenance Drug C Prescribed
Claim rejects for Step Therapy
Maintenance Drug A Prescribed
First Fill - Drug A filled for 31 days at retail
Second Fill - Drug A filled for 31 days at retail
First 31 day fill at Retail
Can change to 90 day fills at any point within this process
If Drug A didn’t work and you move to the next step, 2 more Retail fills are allowed
90 day fill required – Mail Order
90 day fill required – Retail
Second 31 day fill at Retail
First Fill - Drug B filled for 31 days at Retail
Second Fill - Drug B filled for 31 days at Retail
90 day fill required – Mail Order
90 day fill required – Retail
2 Retail fills of 31 days are allowed before a mandatory 90 day fill at either Mail or Retail
This process will continue for other drugs in the Step Therapy process