What is Step Therapy?
Finding ways to manage and treat psoriasis can be quite a journey. Oftentimes, it can feel like there are many different paths to explore, and determining which 1 works best for your psoriasis may not always be clear. There is also the added step of getting treatments approved by your insurance company, which can sometimes add frustration to the journey.
What is a step therapy program?
Step therapy programs are ways that help manage the rising costs of prescription drugs. The programs also were created to encourage cost-effectiveness and safe medicine use. Step therapy is a type of prior approval.
This means that in order to receive coverage for a particular drug, you may need to first try a proven, cost-effective drug that is on an approved list. You will try that drug before the insurance company will approve you to move up a "step" to a more expensive drug.
Basically, an insurer wants to know that the less expensive drug options do not work before they will cover the more expensive drug. This helps keep costs down for members. Sometimes step therapy is referred to as "fail first." That is because it can be viewed as failing first-line treatments before being approved for second-line treatments.
How does a step-therapy program work?
First, your insurance company will need to see that you have tried certain first-line drugs. You must try 1 or more of these drugs before your insurance will approve and cover second-line drugs.
What are first-line drugs?
First-line drugs are treatments that have been proven to be safe and effective. These treatments also tend to be more cost-effective. In the case of psoriasis, this may include topical drugs or topical corticosteroids.
What are second-line drugs?
Second-line drugs tend to be less preferred or more costly treatment options compared to first-line drugs.
In most cases, your doctor will start by prescribing you a first-line drug that is right for your condition. However, your doctor may find that a first-line drug is not right or effective for you. In these cases, your doctor will make the case that the second-line drug is the better option for you. This process is called a "prior authorization request." Your doctor will complete a prior authorization form for the insurance company.
What are the pros and cons of step therapy?
Pros of step therapy
People in favor of step therapy programs believe that they help keep costs down and reduce risks. Those people also say that the programs allow people to explore alternate drug therapies.
Cons of step therapy
People who are opposed to step therapy programs suggest that they can negatively impact people by exposing them to unnecessary or ineffective treatments. They also suggest that the programs may increase the costs of certain treatments.
Many people with health conditions and their advocates say that step therapy makes it harder for people to stick to their treatment plans. They may also self-medicate because they feel they cannot access the treatment plan they prefer.
Some states have laws to help people access the treatments they need. For example, some people in Illinois may be exempt from following step therapy programs. If a person in that state has already proven that a certain treatment failed or they were intolerant to a specific drug, they can move to the next treatment step.
Lawmakers are currently reviewing and voting on step therapy bills at both state and federal levels.
Have you experienced step therapy when trying treatment for your psoriasis? Share your experience with us!
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