MEDICAL ASSOCIATES HEALTH PLANS

BPH STEP THERAPY

The BPH STEP THERAPY allows for the coverage of UROXATRAL & PROSCAR when the participant has used first-line drugs for treatment of benign prostatic hyperplasia, BPH, and when the first-line drugs have failed to effectively treat the participant’s medical condition due to inadequate symptom control of side effects.

BPH Step Therapy: UROXATRAL & PROSCAR will be covered if dispensed within 130 days of first-line drugs, “Drugs for BPH” (doxazosin and terazosin); and if medical information indicates a failure of the first-line drug therapies.

If the step therapy rule is not met at the point of service, (when the prescription is processed at the pharmacy), the pharmacy will be directed, via electronic messaging from the PBM, to “Call Dr, use generic first”. Should the practitioner choose to use the second-line drugs, PROSCAR or UROXATRAL without meeting the step therapy criteria, and the participant wants the prescription given special consideration for payment from their prescription drug benefit, the practitioner must contact Medical Associates Health Plans at MAHP and provide additional medical/clinical information. If the medical/clinical information meets criteria for a medical exception to this step therapy, a prior authorization may be granted.

	FIRST-LINE DRUGS	SECOND-LINE DRUGS
MEDICATIONS	CARDURA (doxazosin) HYTRIN (terazosin)	UROXATRAL (alfluzosin HCL) PROSCAR (finasteride)
CRITERIA FOR USE	Driven by formulary status of drug, formulary is closed and MAC policies **Processing of brand name first-line drug will cause ancillary charges to participant if a multi-source drug.	Failure of response to first-line therapy as documented in participants medical record.

KT 05/05