With step therapy, more expensive brand-name drugs are usually covered as a back-up in the program if:
You’ve already tried the generic drugs covered in your step therapy program
You can’t take a generic drug (for example, because of an allergy)
Your doctor decides, for medical reasons, that you need a brand-name drug
If one of these situations applies to you, your doctor can request an override or a “prior authorization” for you, allowing you to take a back-up prescription drug. Once the override is approved, you’ll pay the appropriate copayment for this drug. If the override isn’t approved, you will either have to pay full price for the back-up drug or take an alternative.
If you have more questions, you can go to StepTherapyFacts.com to watch informative videos or call the Express Scripts Pharmacy at the number on your ID card. (This FAQ answer provided by ExpressScripts.)