Step therapy
Step therapy, also called step protocol or a fail first requirement, is a managed care approach to prescription. It is a type of prior authorization requirement that is intended to control the costs and risks posed by prescription drugs. The practice begins medication 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
Physicians and managed care providers may disagree on the proper step therapy,[3] 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.[4] "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
See also
- Health care in the United States
- Prescription drug
- Prescription drug prices in the United States
References
- ^ Jessica S. Banthin, Peter Cunningham, and Didem M. Bernard "Financial Burden Of Health Care", 2001–2004 Health Affairs, January/February 2008; 27(1): 188-195.
- ^ Brenda R. Motheral, PhD; Rochelle Henderson, MPA; and Emily R. Cox, PhD "Investigation showing step therapy reduces managed care costs: Plan-Sponsor Savings and Member Experience With Point-of-Service Prescription Step Therapy", The American Journal of Managed Care Volume 10:457-464 July 2004 Number 7 Pt 1
- ^ Neil J. MacKinnon, Ph.D., R.Ph., Ritu Kumar, M.H.S.A., R.N., "Prior Authorization Programs: A Critical Review of the Literature", Journal of Managed Care Pharmacy 2001 Volume 7 Issue 4:297-303
- ^ FailFirstHurts.org
Further reading
- The Academy of Managed Care Pharmacy - Hosting the Journal of Managed Care & Specialty Pharmacy
- The Academy of Managed Care Pharmacy's Concepts in Managed Care Pharmacy: Prior Authorization