Consider condition in step therapy

May 1, 2007

THE BEST STEP therapy programs first consider medical evidence regarding patient outcomes when identifying drug classes for inclusion, according to industry experts.

THE BEST STEP therapy programs first consider medical evidence regarding patient outcomes when identifying drug classes for inclusion, according to industry experts.

"The strongest candidates are typically medications that are clearly second line to other drugs based on national clinical guidelines or good practices," says Edmund Pezalla, MD, MPH, vice president, medical director, Prescription Solutions. "In classes where good generic alternatives exist, branded products also are common to these programs."

Antidiabetic medications can be considered for step therapy. "With several newer agents on the market and at a fairly high cost compared with generic metformin and/or sulfonylureas, there is an opportunity to establish first-line and second-line agents," he explains.

HIV drugs and drugs used in cancer chemotherapy are classes of drugs that also might be appropriate for step therapy, adds Rogers.

STEP INTO THE FUTURE

As new generics become available in key classes and "me-too" drugs are introduced into a market where cheaper alternatives exist, there will be more opportunity for step therapy programs to have a financial impact, Dr. Pezalla believes. "Increasingly, managed care organizations and others will rely upon these programs to keep pace with pharmaceutical product releases in order to deliver the best clinical and financial outcomes. This will make it even more important that the programs are based on national guidelines and good practice."

Ultimately, step therapy will allow easier access to medications for members who meet guidelines, decrease impact to operations and reduce cost. "As more information becomes available to the claims system, data integration will make step therapy and prior authorization smarter processes, incorporating diagnosis as well as utilization into the logic," Dr. Pezalla says.

-Tracey WalkerCommentary is independent of source data