Step therapy

In managed medical care step therapy is an approach to prescription 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. Also called step protocol or a fail first requirement, and is a type of prior authorization requirement.

Recent trends in prescription drug prices in the United States has led to an increased 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 when possible allows health care plans to pursue both of these 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 such as Fail First Hurts, have detailed the pitfalls of step therapy. "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.

The Academy of Managed Care Pharmacy’s Concepts in Managed Care Pharmacy: Prior Authorization

...
Wikipedia