2. Many beneficiaries are taking drugs that are commonly subject to step therapy.  If such beneficiaries have followed the step therapy protocol for a Part D plan and then change Part D plans, are they required to begin the process of step therapy again for the drug in the new plan?

Beneficiaries in such a situation must apply for an exception to the step therapy requirement of the new plan.  For such an exception request, beneficiaries must show the plan that they have previously followed the step therapy protocol.  For beneficiaries who have requested exceptions to the step therapy protocol because of adverse side effects of alternative drugs, the exception must be requested for the new Part D plan as well.  HAP has created an Exceptions Flowchart and an Appeals Flowchart to clarify the processes for each.

(Back to Questions about Plan Formularies)