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Step Therapy programs require the use of one or more first line drugs before a medication subject to step therapy is utilized. The goal of step therapy is to ensure that safe and cost-effective drugs are utilized based on nationally accepted treatment protocols or well documented clinical drug studies. The criteria has been established based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). Step therapy is a process by which coverage of a drug is dependent upon the prior use of a different, first-line drug. No paperwork is involved in this process—it is handled electronically through the pharmacy claims system. These criteria are revised on an on-going basis as clinical information changes, new guidelines, and standards of care are updated.
Step 1 Medications
Step 2 Medications
Trial Required
Diclofenac sodium (Voltaren), EC naproxen (Naprelan), Etodolac (Lodine), Fenoprofen (Nalfon), Flurbiprofen (Ansaid), Diflunisal (Dolobid), Choline Magnesium (Trilisate), Salsalate (Disalcid), Ibuprofen (Motrin), Indomethacin (Indocin/SR), Ketoprofen (Orudis), Ketoprofen SR (Oruvail),
Ketorolac (Toradol), Meclofenamate (Meclomen), Meloxicam (Mobic), Nabumetone (Relafen), Naproxen (Naprosyn), Naproxen Sodium (Anaprox), Oxaprozin (Daypro), Piroxicam (Feldene), Sulindac (Clinoril), Tolmetin (Tolectin/DS) Diclofenac sodium (Voltaren), EC naproxen (Naprelan), Etodolac (Lodine), Fenoprofen (Nalfon), Flurbiprofen (Ansaid), Diflunisal (Dolobid), Choline Magnesium (Trilisate), Salsalate (Disalcid), Ibuprofen (Motrin), Indomethacin (Indocin/SR), Ketoprofen (Orudis), Ketoprofen SR (Oruvail),
Ketorolac (Toradol), Meclofenamate (Meclomen),
Meloxicam (Mobic), Nabumetone (Relafen), Naproxen (Naprosyn), Naproxen Sodium (Anaprox), Oxaprozin (Daypro), Piroxicam (Feldene), Sulindac (Clinoril), Tolmetin (Tolectin/DS)
Step 1 Medications
Step 2 Medications
Trial Required
Sulfonylurea/Biguanide: Glipizide/Metformin,
Sulfonylurea: Glyburide, Glipizide, Glimepiride
omeprazole, pantoprazole, lansoprazole capsules
Hyzaar, Avapro, Avalide, Micardis, Micardis HCT, Diovan, Diovan HCT,
benazepril, enalapril, captopril, fosinopril, lisinopril, quinapril, Atacand, Atacand benazepril HCT, captopril HCT, enalapril HCT, fosinopril
HCT, lisinopril HCT, quinipril HCT, losartan, losartan HCT
Teveten, Teveten HCT, Benicar, Benicar HCT, Tekturna, Edarbi, Amturnide
aclometasone, triamcinolone, Capex, Clobex, Cloderm, Cordran, fluticasone, amcinonide, Derma-Smoothe/FS,
Dermatop, betamethasone, desonide, mometasone,
diflorasone, fluocinolone, Halog, hydrocortisone,
fluocinonide, hydrocortisone, clobetasol, desoximetasone, halobetasol
Step 1 Medications
Step 2 Medications
Trial Required
Zoloft, Paxil CR, Lexapro, Celexa, Sarafem, Pexeva, Prozac weekly,
paroxetine, fluoxetine, fluvoxamine, citalopram, sertraline,
Cymbalta, Pristiq, Wellbutrin, Wellbutrin SR, Wellbutrin XL, Viibryd
lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin
Abilify, Clozaril, Fanapt, Fazaclo, Geodon, Invega, Risperdal, Risperdal
Consta, Risperdal M-tab, Saphris, Seroquel, Seroquel XR, Zyprexa
Depakote, Depakote ER, Depakote Sprinkles, Equetro,
carbamazepine, divalproex, lamotrigine, lithium
Lamictal, Lithobid, Symbyax, Tegretol, Zyprexa
Lescol, Lescol XL, Livalo, Altoprev ER, Mevacor, Pravachol,
lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin
Advicor, Vytorin, Caduet, Crestor, Lipitor, Zocor
Step 1 Medications
Step 2 Medications
Trial Required
Alsuma, Amerge, Axert, Frova, Imitrex, Maxalt, Maxalt MLT,
Migranal, Relpax, Sumavel, Treximet, Zomig, Zomig ZMT
Biguanides: Metformin, Metformin ER Sulfonylurea/Biguanide: Glipizide/Metformin, Glyburide/Metformin
Sulfonylurea: Glyburide, Glipizide, Glimepiride Thiazolidinedione: Actos, Avandia
Kadian, Morphine Sulfate ER, MS Contin, Oxycontin
fluticasone nasal spray, flunisolide nasal spray,
Enablex, Toviaz, Oxytrol, Vesicare, Detrol, Detrol LA,
Sanctura, Ditropan, Ditropan XL, Myrbetriq, Gelnique
Step 1 Medications
Step 2 Medications
Trial Required
Adderall, Adderall XR, Strattera, Focalin, Focalin XR, Concerta, Daytrana,
amphetamine, amphetamine ER, dexmethylphenidate,
dextroamphetamine, dextroamphetamine/amphetamine,
dextroamphetamine ER, methylphenidate, methylphenidate
LA, Ritalin SR, Desoxyn, Dexedrine CR, Dexedrine Spansule, Dextrostat, Vyvanse
Source: http://www.winhealthplans.com/media/uploads/pdfs/Medications%20Requiring%20Step%20Therapy.pdf
CHEMICAL RESISTANCE LIST The information provided is designed to be used as a guide and al information must be checked on a project basis. Data based upon room temperatures. Elevated temperatures will increase the effect of the chemicals upon the elastomers. No guarantees can be given in respect of the information pr inted in this document. E (Excellent)=Little or No Effect G (Good)=M
2012-2013 Nurses’ Letter Regarding Administration of Medication Including Over-the-Counter Medications As you know, Ranney School Health Office maintains Standing Physician Orders for the administration of Advil, Tylenol, and Benadryl (calculated by student’s weight). This means that Advil, Tylenol, and Benadryl can be given to your child with provided parental consent, and notific
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Step Therapy programs require the use of one or more first line drugs before a medication subject to step therapy is utilized. The goal of step therapy is to ensure that safe and cost-effective drugs are utilized based on nationally accepted treatment protocols or well documented clinical drug studies. The criteria has been established based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). Step therapy is a process by which coverage of a drug is dependent upon the prior use of a different, first-line drug. No paperwork is involved in this process—it is handled electronically through the pharmacy claims system. These criteria are revised on an on-going basis as clinical information changes, new guidelines, and standards of care are updated.
Step 1 Medications 
Step 1 Medications 
Step 1 Medications 
Step 1 Medications 
Step 1 Medications