Step therapy is a utilization management technique used by health plans that hinders appropriate and timely access to therapies patients need to properly manage their conditions. Step therapy or “fail first” policies require patients to use treatments preferred by their insurance company before treatment prescribed by their physicians.

Much to the frustration of physician and even to the detriment of patients’ health, when a physician prescribes a particular drug treatment for a patient, the patient’s insurance company may require them to try different medications and treatments before they can access the drug originally prescribed by their physician. In some circumstances, step therapy protocols may ignore a patient’s unique circumstances and medical history. Patients may experience severe side effects and irreversible disease progression from trying and failing on several alternate therapies before ultimately receiving the most effective, physician-prescribed treatment. Not all medications are tolerated by all patients; the disease might be the same but each patient is unique.

P+P United is committed to preventing 3rd party interference with patient care and preserving personalized treatment.

• Delays Treatment – Step therapy or “fail first” policies force patients to go through months of ineffective treatment with second or third choice medications. Along with health setbacks and disease progression, patient copayments/cost sharing accompany these many rounds of ineffective prescriptions and subsequent follow-up treatment visits. Patients spend approximately $35.8 billion annually in drug cost sharing for these failed therapies.
• Discredits Physician Expertise – To find the right medication for a patient’s particular condition, physicians relay on their expertise, experience and extensive training. Patients lose when that medical expertise encounters rigid, unworkable, cost-containment benchmarks of an insurance plan.
• Threatens Personalized Medicine – Obstructing access to therapies interferes with the personalized treatment plans that physicians craft to meet the unique needs of each patient. A treatment that cannot reach patients due to health plan bureaucracy cannot improve a patient’s quality of life or medical condition.

• Red Tape Smothers Quality Care – The time doctors spend fighting insurance plan bureaucracy to get patients access to needed therapies is time that should be spent taking care of patients.