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Step therapy is when your insurance company requires certain steps before they'll pay for your medication. Usually, this means you'll have to try taking a preferred medication before they'll pay for a non-preferred one. Insurance companies use step therapy to control cost.

Step therapy is a process by which insurers (public or private) require patients to take one or more alternative medications before they can access the medicine prescribed by their provider.

To help reduce physician-administered drug costs, CMS authorized Medicare Advantage (MA) plans to use step therapy protocols for physician-administered (Part B) drugs starting January 1, 2020.

If a health plan uses step therapy for certain drugs, it means that a patient can be required to try a lower cost prescription drug that treats a given condition before “stepping up” to a similar-acting, but more expensive drug.

Prior authorization is a requirement by the insurance company to approve certain medications or procedures before they can be covered by insurance, while step therapy is a protocol that requires patients to try a less expensive or lower-risk medication before moving on to more expensive or risky treatments.