Understanding Step Therapy
Prescription insurance plan providers want to be sure that other, more inexpensive, or appropriate medications don’t work for you before they will pay for specific medications. This could imply that you’ll need to try a different drug before receiving coverage for the one your doctor recommended. Step therapy is the name given to this method.
Step therapy is essentially a form of prior authorization, which your insurance provider uses to decide whether or not to cover specific prescriptions. However, many argue that step therapy may harm your health and make it more difficult for you to obtain the medications you require. It could seem a little daunting if you’ve been put through the step therapy procedure. As a Los Angeles pharmacy, we share the details of step therapy for your knowledge.
What Is Step Therapy?
Insurance companies employ step therapy as a cost-control measure and a means of preventing overmedication. They’ll make sure you’ve tried it first if they think there’s a drug that’s less expensive than the one your doctor recommended for you and still works to treat your illness.
Medications are frequently divided into several steps in step therapy. The lowest step (step one) medications are typically covered without any problems. The drugs in question are frequently generic, but not always.
Your insurance provider needs evidence that you cannot take a step one drug before covering the cost of medication in the following level up, or that you attempted it and it was unsuccessful for you. The number of steps varies depending on the insurance company. However, two or three steps are typical.
What Medicines Need Step Therapy?
Step therapy is frequently applied to costly, name-brand drugs that can be replaced by cheaper generic versions. However, there are situations when it’s because the drug isn’t the best option for your symptoms. For instance, step therapy is frequently required by BlueCross BlueShield of Illinois to ensure that you are taking the appropriate medication for your ailment.
Each insurance plan will have a different list of drugs that require step treatment. You can get in touch with your insurance provider or visit their website to find their suggested medicine list. You can learn more about particular drugs there. This includes whether or not they are covered, whether step therapy is necessary, and whether there are restrictions on how much or how frequently you can receive them.
Bottom Line
Step therapy is a kind of limit on prescription coverage. Insurance firms use it to manage costs and stop people from taking drugs they don’t need. However, it can also stop patients from accessing the medication they require.
You have choices if step therapy is necessary for your medication. Ask your healthcare professional to contact your insurance provider or get another prescription.