Commercial Step Therapy 2021

TITLE OF THERAPY (PAR-259) DRUG with STEP THERAPY STEP THERAPY REQUIREMENTS (Non-Medicare) ATYPICAL ANTIPSYCHOTICS ABILIFY MAINTENA (aripiprazole) Use two first line antipsychotics 1st ATYPICAL ANTIPSYCHOTICS ABILIFY MYCITE (aripiprazole) Use two first line antipsychotics 1st Use alendronate, FOSAMAX, risedronate tablets, or ACTONEL (riserdronate) OSTEOPOROSIS THERAPY ibandronate tablets first Use alendronate, FOSAMAX, risedronate tablets, or ACTONEL with Calcium (risedronate) OSTEOPOROSIS THERAPY ibandronate tablets first THERAPY APTIOM () Use generic 1st ATYPICAL ANTIPSYCHOTICS ARISTADA (aripiprazole lauroxil) Use two first line antipsychotics 1st Use alendronate, FOSAMAX, risedronate tablets, or OSTEOPOROSIS THERAPY ATELVIA (risendronate sodium delayed-release) ibandronate tablets first OPHTHALMIC PROSTAGLANDIN THERAPY bimatoprost Use latanoprost first Use alendronate, FOSAMAX, risedronate tablets, or OSTEOPOROSIS THERAPY BINOSTO (alendronate) ibandronate tablets first ANTICONVULSANT THERAPY BRIVIACT () Use generic 1st Use alendronate, FOSAMAX, risedronate tablets, or OSTEOPOROSIS THERAPY BONIVA (ibandronate) ibandronate tablets first ATYPICAL ANTIPSYCHOTICS CAPLYTA (lumateperone) Use two first line antipsychotics 1st ATYPICAL ANTIPSYCHOTICS CLOZARIL (clozapine) Use two first line antipsychotics 1st ANTISPASMODIC THERAPY DETROL LA and DETROL (tolterodine) Use generic 1st ANTISPASMODIC THERAPY DITROPAN XL (oxybutynin) Use generic 1st ANTISPASMODIC THERAPY ENABLEX (darfenacin) Use generic 1st Use alendronate, FOSAMAX, risedronate tablets, or OSTEOPOROSIS THERAPY EVENITY (romosozuman-aqqg) ibandronate tablets first ATYPICAL ANTIPSYCHOTICS FANAPT (iloperidone) Use two first line antipsychotics 1st ATYPICAL ANTIPSYCHOTICS FAZACLO (clozapine) Use two first line antipsychotics 1st Use alendronate, FOSAMAX, risedronate tablets, or OSTEOPOROSIS THERAPY FORTEO (teriparatide) ibandronate tablets first ANTICONVULSANT THERAPY FYCOMPA () Use generic 1st ANTISPASMODIC THERAPY GELNIQUE (oxybutynin) Use generic 1st RESTLESS LEG SYNDROME THERAPY HORIZANT ( enacarbil) Use generic 1st ATYPICAL ANTIPSYCHOTICS INVEGA (paliperidone er) Use two first line antipsychotics 1st ATYPICAL ANTIPSYCHOTICS INVEGA SUSTENNA (paliperidone er) Use two first line antipsychotics 1st

Updated: 1/2021 Commercial Step Therapy 2021

TITLE OF THERAPY (PAR-259) DRUG with STEP THERAPY STEP THERAPY REQUIREMENTS (Non-Medicare) ATYPICAL ANTIPSYCHOTICS INVEGA TRINZA(paliperidone er) Use two first line antipsychotics 1st ATYPICAL ANTIPSYCHOTICS LATUDA (lurasidone) Use two first line antipsychotics 1st OPHTHALMIC PROSTAGLANDIN THERAPY LUMIGAN (brimatoprost) Use latanoprost first ANTISPASMODIC THERAPY MYRBETRIQ (mirabegron) Use generic 1st OPHTHALMIC PROSTAGLANDIN THERAPY RESCULA (unoprostone isopropyl) Use latanoprost first ATYPICAL ANTIPSYCHOTICS REXULTI (brexpiprazole) Use two first line antipsychotics 1st ATYPICAL ANTIPSYCHOTICS RISPERDAL CONSTA (risperidone) Use two first line antipsychotics 1st ATYPICAL ANTIPSYCHOTICS SAPHRIS (asenapine) Use two first line antipsychotics 1st ATYPICAL ANTIPSYCHOTICS SECUADO (asenapine) Use two first line antipsychotics 1st ANTISPASMODIC THERAPY solifenacin Use generic 1st ANTICONVULSANT THERAPY SPRITAM () Use generic 1st Use alendronate, FOSAMAX, risedronate tablets, or OSTEOPOROSIS THERAPY teriparatide ibandronate tablets first ANTISPASMODIC THERAPY TOVIAZ (fesoterodine) Use generic 1st OPHTHALMIC PROSTAGLANDIN THERAPY TRAVATAN-Z (travoprost) Use latanoprost first OPHTHALMIC PROSTAGLANDIN THERAPY travoprost Use latanoprost first Use alendronate, FOSAMAX, risedronate tablets, or OSTEOPOROSIS THERAPY TYMLOS (abaloparatide) ibandronate tablets first ATYPICAL ANTIPSYCHOTICS VERSACLOZ (clozapine) Use two first line antipsychotics 1st ANTISPASMODIC THERAPY VESICARE (solifenacin) Use generic 1st ANTICONVULSANT THERAPY VIMPAT () Use generic 1st ATYPICAL ANTIPSYCHOTICS VRAYLAR (cariprazine) Use two first line antipsychotics 1st OPHTHALMIC PROSTAGLANDIN THERAPY VYZULTA (latanoprostene) Use latanoprost first ANTICONVULSANT THERAPY XCOPRI (cenobamate) Use generic 1st OPHTHALMIC PROSTAGLANDIN THERAPY ZIOPTAN (tafluprost) Use latanoprost first ATYPICAL ANTIPSYCHOTICS ZYPREXA RELPREVV (olanzapine) Use two first line antipsychotics 1st

Updated: 1/2021