{"id":60257,"date":"2023-09-07T14:05:52","date_gmt":"2023-09-07T18:05:52","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=60257"},"modified":"2024-10-25T10:32:30","modified_gmt":"2024-10-25T14:32:30","slug":"step-therapy","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/step-therapy\/","title":{"rendered":"What is step therapy?"},"content":{"rendered":"

Imagine going to the pharmacy to fill a prescription, only to be told that step therapy is required before receiving a prescribed medication. This common occurrence can leave people feeling frustrated and unsure of their next steps. Understanding how it works can help avoid being unprepared or overwhelmed if unfamiliar with step therapy.<\/span><\/p>\n

Step therapy focuses on using cost-effective treatments for various conditions, which may help save money in the long run for insurance companies and the people they cover. However, step therapy rules may cause delays in obtaining the best medication needed at the right time.<\/span><\/p>\n

What is step therapy?<\/span><\/h2>\n

Step therapy is a process used by health insurance companies to manage and control prescription drug costs. Also known as “fail first” or “step protocol,” this process requires patients to try lower-cost medication options before using more expensive treatments. In essence, individuals may be asked first to try a lower-cost medication, such as a<\/span> generic drug<\/span><\/a>, in order for coverage determination to be decided.<\/span><\/p>\n

Prior authorization vs. step therapy<\/span><\/h3>\n

Prior authorization<\/span><\/a> and step therapy are two different things insurance companies might do when deciding if they’ll cover the cost of certain medications. <\/span><\/p>\n