What is step therapy in pharmacy benefits?

• A. Requiring a preferred, lower-cost alternative before approving a higher-cost medication.
• B. Requiring stepwise dose increases for all medicines.
• C. Requiring multiple doctors to approve every prescription.
• D. Providing immediate approval for all medications.

Answer: (A)

Step therapy is a cost-management approach in pharmacy benefits where a patient must first try a preferred, lower-cost medication before a higher-cost option will be approved. The idea is to use an effective, less expensive treatment first and only escalate to more expensive therapies if the initial choice isn’t effective, isn’t tolerated, or isn’t appropriate for the patient. This often involves clinical review or prior authorization to justify moving to a more costly medication when needed. It helps manage overall drug costs while aiming to maintain appropriate care. This differs from simply increasing doses for all medicines, requiring multiple doctors’ approvals, or granting immediate approval for every medication.