Fact Checked

Expensive Drugs Drive Insurers To “Step Therapy”

Expensive Drugs Drive Insurers To “Step Therapy”When you first hear the concept, it doesn’t sound so bad. When it comes to drug treatments, it’s been a long tradition for patients to start out with the oldest option first. These medications have a proven history of success, after all, and they’re also cheaper than the newer alternatives. Only after a patient fails to respond does the doctor move him or her up to a more expensive and more potent medication. And if that doesn’t work, the cycle continues until something does.

Unfortunately, what works in theory can often fall apart in practice. In the case of “step therapy,” the practice falls apart because insurers can effectively veto a doctor’s prescription by refusing to cover a prescribed medication. If a doctor decides that a new medication is so effective that a patient should start using it right away, even if it costs thousands of dollars per month, an insurer can deny coverage of the medication until after its cheaper cousin gets a shot.

That’s not all an insurer can do to interfere with diagnoses, either. If a patient shows a response to an older, weaker drug, an insurer can point to that as a reason to avoid covering any newer drugs even if they would work much better. And on top of that, if a person switches insurance providers, he or she will most likely have to restart the step therapy from step one in order to satisfy the new provider.

Still, not all of the blame for this system should be aimed at the health plans. With such a steep increase in price between old and new treatments, an increase that’s only becoming steeper as time goes on, it’s no wonder that the companies covering the costs are shy about paying for new wonder drugs. Also, doctors are sometimes too enthusiastic about prescribing new drugs, or else patients will demand them even when they don’t need them.

Between all these issues, it’s understandable why health insurance providers would set conditions the way they do. But at the same time, by deciding which medications to cover and when, the insurers are effectively prescribing the drugs instead of the doctors.

Fortunately, you can always get a discount on drugs both new and old when you sign up for a USA Rx pharmacy discount card. It doesn’t cost a cent, and all we need from you is your name and an email address. In exchange, you’ll get up to 75 percent off on prescription drugs at any of the 60,000 participating pharmacies throughout the nation. If you’re interested in finding out more, be sure to email us at [email protected] or else call us at 888-277-3911.

Published September 1st, 2016 by Stephanie Clegg
Fact Checked by Chris Riley

What Does Flomax Do?

How Much Does Adderall Cost?

How to Transfer a Prescription

Was this artical helpful?