Get 2011 Medicare Part D Step Therapy Physician Fax Form

Step therapy, also called step edits, implies that in a given therapeutic class lower cost (or more cost-effective) drugs must be prescribed first prior to allowing reimbursement of more expensive (or less cost-effective) options.

Step therapy is a type of prior authorization.

What is Step Therapy? Step therapy is a type of prior authorization for drugs that begins medication for a medical condition with the most preferred drug therapy and progresses to other therapies only if necessary, promoting better clinical decisions.

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.

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.

Step therapy is a restriction placed on drug coverage by Part D plans and Medicare Advantage Plans. Before your plan will cover a drug, you must first try a different or less expensive drug that treats your condition to see if it will be effective for you.

Medicare Advantage plans may use step therapy for Medicare Part B-covered drugs. Step therapy allows a plan to require an enrollee to try a different, less expensive drug that treats the same condition before it will cover a more costly drug.

Step therapy is a specific type of PA requiring patients to try one or more insurer-preferred medications or treatments prior to implementing a physician recommendation.