Effective Dec. 1, the DC 37 Health and Security Plan is implementing a step therapy program. Step therapy requires participants to try cheaper and preferred medicines for chronic conditions before more expensive drugs. The program, recently adopted by the plan trustees, affects individuals who have new prescriptions for any of the covered drugs. Individuals who are already taking medication covered by the program won’t be affected.

“This may pose an initial inconvenience as participants try a new medication regimen,” said plan Administrator Rosaria R. Esperon. “But we don’t believe members and physicians will have a hard time finding the right drug.” Under the program, doctors will be asked to prescribe “step-one” medication when they prescribe drugs for patients in a covered treatment category for the first time. If the first treatment does not work well, the patient can be given a more costly “step-two” drug.

At pharmacies, the computer network of the drug plan’s administrator, Express Scripts Inc., will flag prescriptions for covered drugs. If the initial prescription is for a more expensive drug, the pharmacists will generally contact the physician to request a new prescription. In some instances, if a physican is unavailable, patients will have to take care of obtaining the new prescription.

The step therapy program follows the co-pay schedule of the union’s prescription drug plan, which has different co-pays for generic, preferred brand-name drugs and non-preferred brand-name drugs. Patients who don’t first try a cheaper step-one drug will have to assume the full cost of their step-two drug. Physicians can contact ESI’s prior authorization department to request a step two drug if they feel a specific patient’s case is unique and requires special handling, but ESI will not automatically approve such requests.

Step therapy drugs are generally used in long-term illnesses. Under the union plan’s mandatory mail-order program, individuals must purchase maintenance drugs by mail after filling three prescriptions at a pharmacy.

The drug categories in the step-therapy program include high blood pressure (Enalapril, Fosinopril), dermatitis and eczema (Temovate, Kenalog), attention deficit hyperactivity disorder (Ritalin, Adderall), asthma and allergy (Beconase, Rhinocort, Allegra), depression (Flouretine, Paraxetine), rheumatoid arthritis (Azulfidine, Palquenil), gastro-esphogeal reflux disease and ulcers (Omeprazole) and diabetes affecting patients over 65 (Glucophage, Metformin).

The step-therapy program should save the drug plan $3.5 million a year. Coupled with additional administrative changes, the trustees’ decision should save $5 million, narrowing the current gap between income and benefits. Members who have questions about step therapy or the drug benefit should call ESI at 1-800-467-2006.