Step therapy in Medicare Advantage requires you to try less expensive medications before the plan will cover more expensive ones. For example, a plan may require you to try a generic medication before covering a brand-name medication. Step therapy can be appealed if medically necessary.
Key Points
- Step therapy: try less expensive medications first
- Plan may require generic before brand-name
- Step therapy can be appealed if medically necessary
- Original Medicare with Medicare Supplement: no step therapy requirements
- An independent agent can help you find plans with fewer step therapy requirements