Calls for Another Look at Step Therapy

Patients and Providers United wholeheartedly agrees with the sentiment – “A patient’s health care provider is in the best position to assess their patients’ medical needs.” – expressed by 58 medical specialists and provider groups that treat nearly every body system. This alliance of medical providers continues to press Xavier Becerra, Secretary of Health and Human Services, to address Medicare Advantage program rules that allow health plans to use misguided step therapy protocols. These calls will continue in order to protect Medicare beneficiaries from misguided utilization management procedures.

Step therapy or “fail first” policies force patients to go through months of ineffective treatment with second or third choice medications before the drug therapy originally prescribed by their doctor is finally covered. Along with health setbacks and disease progression, patient copayments/cost sharing accompany these many rounds of ineffective prescriptions and subsequent follow-up treatment visits. It is more important than ever that the personalized treatment plans physicians craft to meet the unique needs of each patient are not obstructed due to bureaucratic utilization management policies like “fail first.”