How will the Step Therapy program work?
In situations where there is a prescription for a bisphosphonate in claims history in the previous 18 months, the step therapy rule will provide coverage immediately (without requiring a coverage review). All other members will be subject to a coverage review. 5. Can you tell me which types of these osteoporosis medications require a coverage review? Alendronate (generic for Fosamax) is the Plan’s preferred bisphosphonate. Brand name Boniva also does not require a coverage review prior to use. Actonel, Actonel with Calcium and Fosamax Plus D are non-preferred brands and require a coverage review prior to first use. As of April 1, 2010 Forteo® will also require a coverage review. 6. If my provider feels I should remain on Forteo®, how do I obtain a coverage review? You or your doctor can request a coverage review by calling Medco toll-free at 1-800-417-1764, 8:00 a.m. to 9:00 p.m., Eastern Time, Monday through Friday. If the review is approved, you will pay the appropriate specialty cop
