Patients and Physicians Struggle with Step Therapy Policy

Imagine needing medication to feel well but being told you must try a cheaper, less effective drug first. This is the reality many Americans are facing due to “step therapy”, a pharmacy cost-containment practice designed by benefit providers to control rising drug costs.

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Imagine needing medication to feel well but being told you must try a cheaper, less
effective drug first. This is the reality many Americans are facing due to “step therapy”, a
pharmacy cost-containment practice designed by benefit providers to control rising drug
costs.

Patients are frustrated. In a recent article in Stateline, states struggle to help patients

navigate the insurance hurdle known as ‘step therapy’, and patients across the country voiced
their displeasure with the policy. Patients claim they are not just numbers in a cost-
saving game, but rather a human being trying to address unnecessary pain and health
deterioration by getting the more effective medication. They claim that step therapy
feels like a cruel game of trial and error, where the stakes are nothing less than their
well-being.

Stories of Frustration and Pain
Take, for instance, Mary, a patient with chronic arthritis. After years of trying various
medications, her doctor found a drug that finally provided relief. But her insurance
insisted she try cheaper alternatives first, even though she had already gone through
that process. The result? Months of unnecessary pain and limited mobility while she
fought through the bureaucratic maze.

Healthcare providers report similar frustration. Physicians are forced to prescribe
medications they know won’t work as well. Further, providers are not compensated for
the extra time it takes to navigate the bureaucratic hurdles and the process undermines
the trust and rapport built with their patients and shifts focus from care to paperwork.
Physicians say that navigating the appeals process to secure the appropriate
medications is a drag on their practice.

Legislative Solutions
State legislative bodies are working on laws to limit the use of step therapy, making the
process more transparent and easier for patients to get the medications they need.
While these efforts may help, there are other ways that insurance companies can use to
control drug costs without frustrating patients and physicians.

HealthTech can put data to use to help insurance companies continue to offer patient-
centered and affordable healthcare. Step therapy is clearly unpopular with patients and
healthcare providers, while HealthTech companies like RazorMetrics can offer a more
balanced approach to control drug costs that prioritizes patient experience and
streamlines access to necessary treatments.

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Article

Patients and Physicians Struggle with Step Therapy Policy

Imagine needing medication to feel well but being told you must try a cheaper, less
effective drug first. This is the reality many Americans are facing due to “step therapy”, a
pharmacy cost-containment practice designed by benefit providers to control rising drug
costs.

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changing consumer demographics and preferences, marking a shift in their business
strategy to ensure long-term sustainability.

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