What does step therapy involve in Medicare prescription drug plans?

Step therapy in Medicare prescription drug plans is a strategy designed to promote the use of more cost-effective medications before progressing to more expensive treatments. This approach encourages patients to try one or more lower-priced drugs to determine their effectiveness for a patient’s specific condition. By initiating treatment with less expensive options, it can help manage costs for both the patient and the Medicare program while ensuring that the treatment is appropriate for the patient.

This method aims to encourage the use of clinically effective alternatives that may be just as beneficial for a patient without incurring the higher costs associated with newer or more expensive medications. If the lower-priced drugs do not work or cause undesirable side effects, then the patient can be moved on to the more expensive options as needed, making step therapy a cost-effective and patient-centered approach to treatment.

The other choices imply methods that do not reflect the objectives of step therapy. For instance, using multiple expensive drugs, switching to the highest-priced drug automatically, or focusing solely on generic prescriptions does not align with the goal of ensuring that patients first receive clinically appropriate care using less costly options before escalating to higher-cost treatments.