Step therapy, also known as “fail-first” or “step-edit” therapy, is a utilization management strategy used by health insurers to control costs and promote the use of cost-effective treatments. In step therapy, patients are required to try lower-cost or generic medications or therapies first, before progressing to more expensive or advanced treatments. If the initial treatment is unsuccessful or deemed insufficient by the insurer, then the patient may proceed to the next step in the treatment plan, which may involve a higher-cost option. Step therapy aims to ensure that patients receive appropriate and effective treatment while minimizing healthcare costs by starting with the most conservative and cost-effective options. However, critics argue that step therapy can delay access to necessary treatments and interfere with the patient-provider relationship.
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