9 September 2019 - Over the past two decades the use of step therapy or edits by health insurers has increased significantly. 

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.

On the one hand, step therapy protocols provide insurers with leverage to negotiate lower prescription drug costs. On the other, step therapy is considered an onerous condition of reimbursement, particularly given its fail-first implications. That is, step therapy often implies that patients must first fail on a less costly drug before being prescribed a more expensive treatment and having it reimbursed.

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