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.
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.)
*Automated Step Therapy was developed in line with provincial government regulations