Step therapy, also called step protocol or a fail first requirement, is a

managed care The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care ("man ...

approach to prescription. It is a type of

prior authorization Prior authorization is a utilization management process used by some health insurance companies in the United States to determine if they will cover a prescribed procedure, service, or medication. The process is intended to act as a safety and cost- ...

requirement that is intended to control the costs and risks posed by

prescription drug A prescription drug (also prescription medication or prescription medicine) is a pharmaceutical drug that legally requires a medical prescription to be dispensed. In contrast, over-the-counter drugs can be obtained without a prescription. The re ...

s. The practice begins

medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, treat, or preventive medicine, prevent disease. Drug therapy (pharmacotherapy) is an imp ...

for a medical condition with the most cost-effective drug therapy and progresses to other more costly or risky therapies only if necessary. The increase in

prescription drug prices in the United States Prescription drug list prices in the United States continually rank among the highest in the world. The high cost of prescription drugs became a major topic of discussion in the 21st century, leading up to the American health care reform debat ...

has increased the pressure on health care providers to keep down the cost of prescription medication while maintaining high levels of availability to the patient. The use of

generic drugs A generic drug is a pharmaceutical drug that contains the same chemical substance as a drug that was originally protected by chemical patents. Generic drugs are allowed for sale after the patents on the original drugs expire. Because the active c ...

whenever possible allows health care plans to pursue both goals effectively. Physicians and managed care providers may disagree on the proper step therapy, and patients are encouraged to become knowledgeable in managing their own care.

Opponents

Opponents of step therapy, such as Fail First Hurts, have detailed the pitfalls of step therapy.FailFirstHurts.org
/ref> "Fail First is used by health insurers to control costs.It is time-consuming from a physician and patient standpoint, is more expensive from a direct and indirect out-of-pocket cost perspective, denies patients the drugs they need when they need them, and allows payers to practice medicine without a license." They claim that it also has the following disadvantages: * Creating additional barriers, leading people to forgo needed medications * Possibly causing patients' medical conditions to deteriorate, increasing the need for later medical intervention in the future, thus making patients require increasingly-costly medical care * Increasing frustration and incidents of depression * Increasing the risk of non-compliance and self-medication

Opponents

See also

References

Further reading