Step therapy
A formulary file would show the flag for a plan and a drug. This site does not publish Part D formulary pages.
Source: Medicare.gov, Drug plan rules. Page read October 14, 2026.
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Definition · Codes and claim data
Step therapy
Step therapy is a plan rule that asks a person to try a preferred drug before the plan covers a different drug for the same condition. It is a utilization management rule, like prior authorization and quantity limits. Medicare Part D plans can use it. This page does not say whether a plan applies it to a drug.
Questions
Step therapy, answered
Is step therapy the same as prior authorization?
No. Step therapy requires a trial of another drug. Prior authorization requires the plan to approve the drug before it is covered.