Step Therapy

The red tape between you and your meds.

With Step Therapy

with step therapy

Without Step Therapy

without step therapy

This isn't some kind of obstacle course. This is your health.

Maria's Experience

What it's like to go through Step Therapy

You and Your Doctor Make a Choice

I have had psoriasis for 22 years and also suffer from complications of psoriatic arthritis in my back and hips for the past 14 years.

Four months ago, a miracle happened. My doctor prescribed a drug that not only significantly reduced my skin lesions, but also worked to control my arthritis.

For the first time in my life, I felt acceptable. I have hope.

This is the good news.

Your Insurer Decides

The bad news is that my insurance company refused to cover the cost of my prescribed medication and instead demanded that I first fail on “one or more” other, less-effective drugs.

My doctors and I know what the best treatment option is, but my health plan will not provide it.

It seems cruel and unfair that there is something to help me and others yet we cannot use it because a huge insurance company denies us that right.

I don't want to be a pariah anymore. I just want to have the medicine I need to look and feel like everyone else.

maria goldstein
Maria Goldstein (left) and her representative

The Facts

About Step Therapy

2013 step therapy growth

In 2013, nearly 67 percent of commercial insurers were using step therapy. 1

2013 step therapy

In 2013, 75 percent of large employers reported offering employees plans that use step therapy. 2

Step therapy is supposed to save insurers money. Does it?

In a study comparing spending on schizophrenia medications in Georgia's Medicaid program, step therapy saved the state $19.62 per member per month. Cheaper drugs – savings all around. Right?

Wrong. The same study found that after the introduction of step therapy, the Medicaid program had to spend more money on outpatient services – $31.59 per member per month. That's because less-effective meds often led to higher health costs later. 3

Step therapy can be bad for your health

Step therapy can keep people from getting any effective treatment at all. 1, 5-7

Step therapy generates miles of red tape

It takes up to two hours per patient of precious staff time in doctors' offices to manage requests and appeals – taking critical time away from patient care. 8

Bottom line: Step therapy isn't helping the bottom line!

Make a Difference

By contacting your Representative today

Let's start fighting against Step Therapy!

Need more Info?

Here are some frequently asked questions

What is the definition of step therapy?

Step therapy – also known as "fail first" – is a policy developed by health insurers to control costs. Sounds good so far. However, no matter what medication your doctor prescribes, if your insurer believes there's a preferred alternative, you are required to try that first. Only if that drug fails will the original prescription be filled. An insurer may insert several cheaper drugs and wait for them all to fail before agreeing to cover the drug your doctor originally prescribed. This process could take weeks. Or months. Meanwhile, what's happening to your health?

There is little oversight of step therapy. Generally, insurers do not have to prove the effectiveness of their step-therapy policies or even take into account the side effects of their substitute drugs.

What can I do?

Coalitions of patients, doctors and advocacy groups are forming around the country to pressure state and federal governments to ensure every person living with a chronic disease has access to effective treatments in a timely manner. See the map above for groups and activities near you. We invite you to join our mailing list and find out what we're doing and how you can help.

What will you do with my contact info?

We're not selling anything and we're not going to sell your name to someone who is. All we want are more people to help us fight this battle. You and your doctor are the best judges of what kind of treatment you should receive – not your insurance company!

Please sign up today to help us fight step therapy!

SOURCES

  1. Motheral B.R. "Pharmaceutical Step-Therapy Interventions: A Critical Review of the Literature," J Manage Care Pharm. 2011;17(2):143-55.
  2. "Step therapy comeback continues." Journal of Managed Care. September, 2012. Available at http://www.managedcaremag.com/archives/1209/1209.outlook.html. Last accessed January 25, 2015.
  3. Farley, J. et al., "Retrospective assessment of Medicaid step-therapy prior authorization policy for atypical antipsychotic medications," Clinical Therapeutics, 30: 1524-1539, 2008.
  4. Mark, T. et al., "The Effects of Antihypertensive Step-Therapy Protocols on Pharmaceutical and Medical Utilization and Expenditures," American Journal of Managed Care, 15: 123-131, 2009.
  5. Cox ER et al. "Health plan member experience with point-of-service prescription step-therapy," J Manag Care Pharm. 2004;10(4):291-98.
  6. Clinical and financial outcomes associated with proton pump inhibitors prior-authorization program in a Medicaid population," Am J Manag Care. 2005;11(1):29-36.
  7. Yokohama K et al. "Effects of step-therapy program for angiotensin receptor blockers on antihypertensive medication utilization patterns and cost of drug therapy," J Manag Care Pharm. 2007;13(3)235-44.
  8. Dermatology Nurses Prior Authorization Advisory Board. Macon, GA. Feb 2015. Cited at https://www.prescriptionprocess.com. Last accessed June 12, 2015.

Still have questions?

Call 866-204-8172 or email questions@steptherapyinfo.org for more info

Step Therapy Info
1800 Diagonal Rd., #360 Alexandria,, VA 22314
Phone: 866-204-8172