Step therapy
Encyclopedia
In managed medical care
step therapy is an approach to prescription
intended to control the costs and risks posed by prescription drug
s. The practice begins medication
for a medical condition with the most cost-effective and safest drug therapy and progresses to other more costly or risky therapies only if necessary. Also called step protocol, a fail first requirement, or a prior authorization requirement.
Recent trends in prescription drug prices in the United States has led to an increased pressure on health care providers to keep down the cost of prescription medication while maintaining high levels of availability to the patient. The use of generic drugs when possible allows health care plans to pursue both of these goals effectively. Physicians and managed care providers may disagree on the proper step therapy and patients are encouraged to become knowledgeable in managing their own care.
Managed care
...intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on...
step therapy is an approach to prescription
Medical prescription
A prescription is a health-care program implemented by a physician or other medical practitioner in the form of instructions that govern the plan of care for an individual patient. Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist or other therapist....
intended to control the costs and risks posed by prescription drug
Prescription drug
A prescription medication is a licensed medicine that is regulated by legislation to require a medical prescription before it can be obtained. The term is used to distinguish it from over-the-counter drugs which can be obtained without a prescription...
s. The practice begins medication
Medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
for a medical condition with the most cost-effective and safest drug therapy and progresses to other more costly or risky therapies only if necessary. Also called step protocol, a fail first requirement, or a prior authorization requirement.
Recent trends in prescription drug prices in the United States has led to an increased pressure on health care providers to keep down the cost of prescription medication while maintaining high levels of availability to the patient. The use of generic drugs when possible allows health care plans to pursue both of these goals effectively. Physicians and managed care providers may disagree on the proper step therapy and patients are encouraged to become knowledgeable in managing their own care.
See also
- Prescription drugPrescription drugA prescription medication is a licensed medicine that is regulated by legislation to require a medical prescription before it can be obtained. The term is used to distinguish it from over-the-counter drugs which can be obtained without a prescription...
- Prescription drug prices in the United StatesPrescription drug prices in the United StatesPrescription drug prices in the United States are the highest in the world. "The prices Americans pay for prescription drugs, which are far higher than those paid by citizens of any other developed country, help explain why the pharmaceutical industry is — and has been for years — the most...
- Managed CareManaged care...intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on...
- Health care in the United StatesHealth care in the United StatesHealth care in the United States is provided by many separate legal entities. Health care facilities are largely owned and operated by the private sector...
Further reading
- The Academy of Managed Care Pharmacy - Hosting the Journal of Managed Care Pharmacy