Step therapy

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Step Therapy

Step therapy (pronounced: stɛp θɛrəpi), also known as Fail First policy, is a type of Prior Authorization for prescription drugs where the patient is required to try one or more specified lower-cost medications before the higher-cost drug is approved by the insurance company.

Etymology

The term "step therapy" is derived from the process itself, where patients are guided through different "steps" or stages of medication before reaching the most expensive or high-risk treatment. The term "fail first" comes from the concept that the patient must "fail" on the lower-cost or lower-risk treatments before moving on to the next step.

Process

In step therapy, the first line of treatment usually involves generic or over-the-counter medications. If these are not effective or cause adverse reactions, the patient can then "step up" to more expensive or riskier medications. This process is guided by a Treatment Algorithm which is designed by the insurance company or healthcare provider.

Related Terms

  • Prior Authorization: A requirement that a health care provider obtain approval from the health insurance plan to prescribe a specific medication for a patient.
  • Fail First: A policy where a patient is required to try and fail with one or more medications before a more expensive drug is approved.
  • Treatment Algorithm: A step-by-step procedure designed to deliver the most appropriate treatment for a specific condition or disease.

Criticisms

Critics of step therapy argue that it can delay access to the best treatment options and can lead to negative health outcomes if the initial treatments are not effective. Advocates argue that it is a necessary cost-control measure and can help prevent overuse of expensive medications.

External links

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