Automated Step Therapy
Paperless Prior Authorization for Prescription Drugs
What will you get?
- Cost-savings for you and your family
- Eligible claims automatically approved and paid
- A seamless pharmacy experience by following the steps
Paperless Prior Authorization for Prescription Drugs
What will you get?
Paperless Prior Authorization for Prescription Drugs
What will you get?
Medavie Blue Cross has clinically separated drug options into first and second-step options; first-step options are more cost-effective and save you money.
First and second step drugs deliver the same health outcomes and in eligible cases, your co-pay doesn’t change.
Your first step for treating a condition is to access a first-step drug that is more cost-effective.
If a first step therapy option doesn't deliver or stops delivering the health benefits you or your health professional expect, you will automatically be covered for the second step alternative.
Step 1: Start with a first-step drug
Step 2: If needed, you can qualify for a second-step drug
You may have been initially prescribed a second step drug.
If you have not tried any first-step therapy options, work with your health care provider to switch your prescription to a first-step drug to try first.
It's easy to switch to a first-step drug. A pharmacist can support you by completing a therapeutic substitution. You don’t have to return to the health professional who provided the prescription or leave the pharmacy empty-handed.
Download the Medavie Mobile app
to review your coverage and drug eligibility
We recommend checking if a prescription drug is first or second-step before leaving your doctor’s office and getting to the pharmacy.
It’s easy to check:
• Open the Medavie Blue Cross Mobile app, Check My Coverage, Drugs
• Enter the name of the drug being considered
• If you have full coverage, the message shows “Drug is a benefit”
• When you need to try a first-step medication first, the message shows “Preferred or Step Drug must be submitted” (or “Special Authorization Required” in Quebec*). Your health care provider can advise you on the best first-step medication.
Download the Medavie Mobile app
to review your coverage and drug eligibility
We recommend checking if a prescription drug is first or second-step before leaving your doctor’s office and getting to the pharmacy.
It’s easy to check:
• Open the Medavie Blue Cross Mobile app, Check My Coverage, Drugs
• Enter the name of the drug being considered
• If you have full coverage, the message shows “Drug is a benefit”
• When you need to try a first-step medication first, the message shows “Preferred or Step Drug must be submitted” (or “Special Authorization Required” in Quebec*). Your health care provider can advise you on the best first-step medication.
Some members may qualify for a second-step alternative treatment but may need to take a few additional steps:
Do you have proof that you’ve taken the first-step drug, but we don’t have your history on our system?
Do you have a health-related reason for needing to start on a second-step therapy without initially trying a first-step option?
Check the summary of benefits in your booklet (often available when you log in to your account) for Automated Step Therapy or if you do a drug search on the Mobile app message “Preferred or Step Drug must be submitted” will show.
Prior Authorization is a pre-approval process that determines reimbursement eligibility for particular benefits.
No, once the drug is in your history it automatically remains eligible provided you have continued to take the second step or a first step drug over in the past two years.
Drug manufacturers use a wide range of criterion in setting the prices for individual drugs, and a higher cost is no assurance of better outcomes. Whether it is first- or second- step, all drugs have been fully reviewed for safety and effectiveness by Health Canada.
If you have questions on Automated Step Therapy you can reach us at 1-877-849-8509 from Monday to Friday between 8.00 AM - 5.00 PM local time.
*Automated Step Therapy was developed in line with provincial government regulations