Step therapy, or fail first, is an insurance practice that requires the least expensive drug in any class to be prescribed to a patient first, even if clinicians believe a different therapy is medically in the best interest of the patient’s condition.
Forcing stable patients onto an insurer-preferred medication can result in increased symptoms, side effects and even relapse. By limiting the array of medication options, both physicians and consumers are forced to compromise their treatment decisions in a way that is dangerous, time-consuming and more expensive in the long-term.
Our position: Oppose
U.S. Pain Foundation believes treatment decisions should be kept in the hands of clinicians and their patients, and that these decisions should be made based on the patients’ best interest, not the insurers.’ If step therapy is allowed, patients and their health care providers should at the very least have access to a clear and speedy process for an exemption. Read our full position statement here.
Examples of U.S. Pain’s efforts
- Congress introduces step therapy act, state efforts continue
- U.S. Pain Advocacy Network revitalizes national coalition
- Iowa patients celebrate passage of fail first reform bill into law
- New York pain patients ring in the New Year with step therapy reform
- “Understanding Step Therapy” – Prescription Process (video)
- “Step Therapy 101” – The Coalition for Safe and Innovative Medicine (handout)
- “Fail First Hurts” – Global Healthy Living Foundation (campaign)
- “The Ethics Of ‘Fail First’: Guidelines And Practical Scenarios For Step Therapy Coverage Policies” – Health Affairs (study)