Part B Step Therapy Program for members of PrimeWest Senior Health Complete (HMO SNP) and Prime Health Complete (HMO SNP)

What is Step Therapy?

In general, PrimeWest Health requires members to first try lower-cost drugs (that often are as effective) before covering drugs that cost more. For example, if Drug A and Drug B treat the same medical condition, and Drug A costs less than Drug B, a member is required to try Drug A first. If Drug A does not work, Drug B will then be covered.

Part B Step Therapy applies to medically administered drugs. These are things like intravenous (IV) medications or injections (shots). We use Step Therapy to ensure members get high quality care and use drugs in a safe and effective way.

Our goal is to help you get the best results from your medications at the lowest possible price. This program will help you and your health care provider use available biosimilar drugs rather than more expensive brand name drugs.

• Part B Step Therapy Program

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DHS_Approved_01/31/2025
Updated_02/03/2025