‘Step Therapy’ Usually Not What the Doctor Ordered

Proponents say “step therapy” will save the healthcare system big money while still allowing patients the medications they need. Opponents call it “fail first” and insist that the practice of having patients try cheaper versions of prescribed medications—with insurers paying for the more expensive variety only if the cheaper drug doesn’t do the job—is a bitter pill to swallow. Some clinicians claim the practice, which in effect has insurers overriding a prescriber’s choice of medications at times, makes the patient pay by virtue of having to suffer through ineffective treatment. Other experts have argued that it’s a matter of robbing Peter to pay Paul, as some patients end up making multiple trips to their prescribing physician—or, more costly, the emergency room. State pharmacy associations have issued statements opposing step therapy, but so far only Connecticut and Maryland have imposed limits. Measures have failed to pass through legislatures in some states, while a few others have legislation pending.