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Automated Step Therapy

Get started with Automated Step Therapy

Introducing an innovative drug program

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.

How does the program work?

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.

How does Automated Step Therapy work at the pharmacy?

Step 1: Start with a first-step drug

  • Your health care provider diagnoses you with a condition needing treatment.
  • You’re prescribed a first-step drug (cost-effective option), and your claim is automatically approved and paid.

Step 2:
If needed, you can qualify for a second-step drug

  • If the first step drug doesn’t deliver or stops delivering the desired health benefits, then you can try a more costly second step drug.
  • You are seamlessly eligible for a second step drug at the pharmacy. The claim will automatically pay at the same co-pay as the first step drug. Please note: actual out of pocket will be dependant on drug cost and plan design.

Was your drug not eligible for coverage?

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.

Accessing Second-Step Drugs – Extra Steps

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?

  • Call our contact centre at 1-888-873-9200 or apply for prior authorization.
    (Collect your proof, receipt or claims history, and be ready to email/fax it in when you call the contact centre.)

Do you have a health-related reason for needing to start on a second-step therapy without initially trying a first-step option?

  • Work with your physician to apply for prior authorization.
    (Submitting a prior authorization is not a guarantee of an approval for a second step therapy.)

Frequently asked questions

Need help? Give us a call.

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