Step therapy, or “fail first,” does what it sounds like, explains a new video from the Alliance for Patient Access. Patients must go through a series of steps, taking other medications and failing on them. Only then will the insurance company pay for the medication originally prescribed by their doctor.
The process saves money for insurance companies. But the consequences can be complicated – and potentially hazardous to patients’ health.
As “Understanding Step Therapy” explains, requiring patients to fail first introduces several consequences. It can:
- Delay access to medications treating chronic and painful diseases
- Allow for disease progression as patients wait for their medication
- Result in nearly one in five patients receiving no treatment at all
- Interfere in the physician-patient relationship
- Burden clinics with administrative tasks that distract from patient care.
Policy solutions can help limit step therapy’s negative effects on patients and patient care, the video explains. In particular, “Understanding Step Therapy” suggests that policy solutions should:
- Implement standards and regulatory oversight to ensure patient safety
- Ensure rules are based on published, peer-reviewed clinical guidelines
- Establish basic exemption requirements so physicians can bypass these policies when medically necessary
- Ensure that the exemption request process is transparent.
With the help of these solutions, the video explains, physicians can continue to direct patient care. And patients can enjoy more direct access to the medications their physician prescribes.
The new video is part of AfPA’s PrescriptionProcess.com campaign to highlight the impact of step therapy on patient care. Watch “Understanding Step Therapy” to learn more.