Medicare Advantage drugs with special requirements

Some drugs have special requirements that must be met before WellFirst Health — Provided by SSM Health Plan — will cover them. Those requirements are:

  • Step therapy drugs require your provider to first prescribe alternative options that are generally more cost effective without compromising quality. Step therapy may be waived if determined to be medically necessary.
  • Prior authorization is required for certain drugs. This process must be completed by your doctor before you fill your prescription.

If your physician believes that you require a certain medication that is not on your formulary, normally requires step therapy or exceeds a quantity limit, he or she may request an exception through the preauthorization process.


  • Requests for coverage may be denied or dismissed unless all required information is received.
  • Your provider’s office will receive a response via fax.
  • For urgent requests, please call 1-866-270-3877 (TTY: 711).

WellFirst Health — Provided by SSM Health Plan — Medicare D Coverage Determination form

Hospice Primary Billing form

BvD ESRD dialysis-related drugs


See the rest of our list of drugs with special requirements.

Questions? Contact us.

Senior man using phone and laptop in his living room.Members
Talk with our Customer Care Center at 1-877-301-3326 (TTY:711).
Not a member?
Talk with one of our Medicare sales reps at 1-833-551-0565 (TTY:711) You can also call to ask for information in alternate formats and languages. 
View our Medicare disclaimers
Updated 10/1/21