Step Therapy

Prescription drug costs can be a significant portion of an employer’s overall health plan, but putting a step therapy program in place can help control those costs. In fact, it’s one of the most effective cost control techniques available. 

When a member of your plan is diagnosed with a specific condition for which there are multiple treatment options available, a step therapy program requires that they begin with the most cost-effective clinically appropriate medication first. If that option does not effectively treat the member’s condition, their provider can recommend stepping up to the next level of treatment. 

For most conditions, there is more than one prescription medication available. Sometimes a prescriber will choose a specific drug because they’ve seen other patients find success with that medication or because they’re simply more aware of that specific medication. 

Sometimes the member may ask for a specific medication because a friend or family member did well taking it. Ads for prescription medications are also common on television and in magazines, so sometimes a member’s request for a specific drug is influenced by simple exposure to the name. 

But the fact that another patient or a friend did well with a certain medication doesn’t mean that it’s the right medication for someone else. Every individual’s body chemistry is different and may react differently to medications. 

Step therapy recognizes this and allows for the option of stepping up to the next medication when needed. But at the same time, it allows for cost control by requiring members to start at the first level to see if that drug will treat their condition effectively before moving to a higher-level medication. 

Ultimately, it’s important to balance an employer’s need for cost containment with their desire to provide a plan that takes care of their employees. Step therapy can help employers achieve that balance in their prescription benefit plan.

At MaxCare, we work closely with each of our clients to customize a plan to fit their specific needs.