Step Therapy

Are there any restrictions on my coverage?

Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include:

• Prior Authorization: Brand New Day requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval from Brand New Day before you fill your prescriptions. If you don’t get approval, Brand New Day may not cover the drug. Please visit our Part D Prescribed Drugs: Prior-Authorization, Coverage Determination, and Exception’s page.
• Quantity Limits: For certain drugs, Brand New Day limits the amount of the drug that Brand New Day will cover. For example, Brand New Day provides 18 tablets per prescription for sumatriptan succinate oral. This may be in addition to a standard one-month or three-month supply.
• Step Therapy: In some cases, Brand New Day requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, Brand New Day may not cover Drug B unless you try Drug A first. If Drug A does not work for you, Brand New Day will then cover Drug B. You can find out if your drug has any additional requirements or limits by looking in the formulary. More information about the restrictions applied to specific covered drugs, prior authorizations, and step therapy restrictions is available on the Covered Medications page on our website or refer to your Evidence of Coverage. You can ask Brand New Day to make an exception to these restrictions or limits or for a list of other, similar drugs that may treat your health condition.

Additional Resources: