Step Therapy Reform

Step Therapy Reform What is it?

Step therapy, or “fail first”, is a policy used by health insurers that requires patients to try and fail one or more formulary-covered medications before providing coverage for the originally prescribed non-formulary or non-preferred medication. Insurers implement this policy in an effort to try to maintain elevated health care costs.

What this means for patients:

Step therapy can lead to serious negative patient outcomes. Some patients are required to try up to 5 different medications with durations lasting up to 130 days per medication. This practice inhibits physicians from being able to provide individualized care, can sacrifice valuable treatment time, and may cause patients to suffer unnecessarily. Also, step therapy can lead to increased costs for patients if it is not carefully managed.

FSR Policy:

The Florida Society of Rheumatology knows that a physician’s medical decision-making expertise in consultation with his patients should drive treatment decisions. Basing treatment decisions on cost rather than clinical considerations ignores important variations that may exist among patients in terms of safety, efficacy and tolerability in drug classes. Physicians should have the authority to override decisions based on a patient’s personal medical history and what they deem to be in the best interest of the patients.