FOCUS ON Protecting Consumers

Step Therapy Reality Check

Myth: Step therapy forces patients to take and fail medications other than what their doctor has prescribed.

Reality: Health plans use step therapy to promote quality and efficacy. Step therapy promotes consumer access to proven effective drugs while keeping their out-of-pocket costs for those drugs as low as possible. An exception process also exists for doctors to provide the patient history and experience to warrant the brand-name drug.

Myth: Step therapy protocols can be harmful to patients both financially and physically, causing an undue wait for the proper treatment and in some cases a worsening of a person’s medical condition.

Reality: Step therapy protocols actually protect patients both financially and physically. Often doctors prescribe the “newest” drugs, even when those drugs lack clinical data of their value. Often, new brand-name drugs rushed to market are later pulled for safety reasons or the federal FDA mandates “black box” warnings about side effects that may actually harm patients.

Myth: Step therapy is a cost savings tool for insurers.

Reality: Step therapy saves money – for consumers. Eliminating step therapy could cost consumers more– both in higher premiums to account for overall increases in drug costs and, more importantly, in higher co-payments and out-of-pocket costs for the more expensive drugs.

Myth: Proposed legislation will ensure patients have access to the medicines their doctors prescribe.

Reality: New York law already ensures patients will get a specific drug their doctors prescribe. When a doctor checks the “Dispense As Written” box on the prescription, the named drug must be filled by the pharmacy.

OPPOSE S.3419-B/A.2834-B.