Understanding Step Therapy

 

What is Step Therapy?

Step therapy  is an insurance company tactic that often requires patients to “fail first” on one or more drugs before getting the medicine that doctors originally prescribed.

What Do I Need to Know about Step Therapy?

When a physician prescribes a particular drug treatment for a patient, the patient’s insurance company may require them to try different medications and treatments before they can access the drug originally prescribed by their physician. This protocol is known as “step therapy” or “fail first.” Step therapy protocols may ignore a patient’s unique circumstances and medical history. That means patients may have to use medications that previously failed to address their medical issue, or – due to their unique medical conditions – could have dangerous side effects.

While step therapy can be an important tool to contain the costs of prescription drugs, in some circumstances, it has negative impacts on patients. Step therapy policies can lead to delayed access to the most effective treatment, severe side effects, and irreversible disease progression

The Autoimmune Association supports policy reforms that curtail delays to care that our patients vitally need by establishing clear timelines for insurer responses to requests for exceptions and ensuring that patients who are successfully using a treatment do not have to switch.

For More Information

For more information about the work we’re doing in individual states to change step therapy policies, please visit the State Access to Innovative Medicines Coalition.

Help Change Policy

Urge your federal representatives to support the Safe Step Act.