Meaning of Step Therapy
Step therapy is a technique applied by health insurers in controlling cost of treatment in health care. Insurers use step therapy to knit the amount of cash spent on certain medications. Under this plan, patients are required to first try the drugs chosen for them by their insurer. These drugs are cheaper than the ones prescribed to the patients by their doctor. Step therapy is also called fail first policy. This is because a patient must first try and fail on cheaper drugs before the insurer can provide cover for the medication originally prescribed. In some instances, a patient may be expected to try more than one alternative drug which may impact negatively on some patients.
Example of Step Therapy
To break it down further, let’s have a look at a simple example of step therapy. Let’s say you have an allergy and try out an over-the-counter drug to help curb the condition, but unfortunately, it doesn’t work as it should control the symptoms. Your doctor and insurance provider then prescribe a well-known prescription drug that still doesn’t offer any relief as expected. The only option left is to use more expensive medication still following the same step therapy procedure as required by the insurance service provider. As you can see, the third medication works perfectly, but you still had to try out the first choice drugs for the costs to be covered.
Impacts of Step Therapy on Patients
According to insurers, step therapy lowers cost of health care while maintaining quality. In some situations, these outcomes have been achieved. However, in some cases step therapy can have opposite impacts. These are;
- Prevents patients from inappropriate medicine
The intention of step therapy is to use cheaper drugs and therefore save costs on treatment. This has been achieved in some situations where patients have been treated with low cost medication. However, step therapy may expose a patient to inappropriate medication if proper care is not adhered to. This may lead to serious side effects which can be life threatening. When a patient is using the original prescribed medication by the doctor, they are appropriately warned of the side effects and contraindications of the drugs. They are therefore aware of the side effects they can consider mild and the ones they can stop the medication and seek instant health care
- Delay in Right Medication
Under step therapy, patients must try alternative medications severally before they are allowed to take the drugs their doctors had prescribed. This bars the patients from accessing the right treatment from the start. As a result, many patients are denied chances of getting an effective treatment. The disease can progress and become more severe. Therefore a patient may be exposed to life-threatening risks in the long run. Furthermore, in few cases, step therapy may prevent a patient from getting treatment at all which make some medical conditions worse. This means that even some manageable conditions develops into diseases. The patients under step therapy may not notice improvement while on the cost-effective medication. It may only result to time wasting in hospitals and anxiety out of worsening medical condition.
- Higher health cost in later stage
Studies have shown than step therapy may only be cost effective in the short run. As the therapy continues, more money is spent especially on outpatient services. Therefore, step therapy may not result to the anticipated effect of lowering total costs but rather it can increase the costs of health care.
— Zigverve.com (@zigverve) March 16, 2016
Lastly, the step therapy procedure is criticized for its unnecessary delays that can potentially lead to dire situations like worsening of a chronic condition. Why not go for the best possible treatment option from the start rather than try cheaper ineffective options which may not work? In addition to this, you will have to wait for the medications to get approval from your service provider.