Step Therapy/Fail First Practices

Step Therapy/Fail First Practices

Man walking with dog at the beachFail First policies — or Step Therapy — are an insurance practice that requires the least expensive drug in any class to be prescribed to a patient first, even if a patient’s physician believes a different drug is medically in the best interest for the patient’s condition.

There are currently no time limits or restrictions placed on these Fail First policies. Patients, including those with serious and degenerative medical conditions, can be forced to prove that cheaper and often less effective treatments have failed to adequately treat a patient’s condition for an indefinite period of time before the agent initially prescribed by the physician is paid for by the insurance company.

This practice has the potential to result in serious negative consequences for consumers and the public health system. By limiting the array of medication options, both physicians and consumers are forced to compromise their treatment decisions in a way that is dangerous, time consuming and more expensive in the long-term.

http://www.uspainfoundation.org/advocacy-fail-first-step-therapy.html

http://www.nytimes.com/2014/08/04/opinion/adventures-in-prior-authorization.html?_r=2

http://failfirsthurts.org/ffh/

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