30 Second Insurance Tips©

Tip #328- What Is “Step Therapy”?

You present your doctor’s prescription – for what you presumed to be a routine brand name medication – at the pharmacy, only to be told that your insurance plan requires you to try a generic alternative.
Remember when HMO’s used to actually manage care? Welcome (back) to the world of pharmacy benefit management. which may also include pre-certification of many drugs.
Critics of step therapy and cost containment strategies rail against insurers interfering with the doctor patient relationship, often sighting cases where a delay in getting “the right medication” resulted in even more costly complications.
Employers and covered members should consider what premiums would look like without anymanagement.
Who would get medications if the underlying premiums were simply unaffordable?