Traditionally, pharmaceutical step therapy ensured the use of themost appropriate and clinically sound drug therapy for patientswith specific diseases or conditions. More recently however, steptherapy has been used as a cost containment tool by health plansand hospitals alike.
Traditionally, pharmaceutical step therapy ensured the use of the most appropriate and clinically sound drug therapy for patients with specific diseases or conditions. More recently however, step therapy has been used as a cost containment tool by health plans and hospitals alike.
Step therapy promoted through the use of online claims edits, prior authorization or implementation of approved guidelines, allows the payer to promote the use of proven and cost-effective therapy prior to the use of more costly treatments, according to Alexander M. Gilderman, PharmD, vice president of Ventegra, a La Jolla, Calif.-based contracting service organization focused on the delivery of transparent pharmaceutical services.
From a managed care executive perspective, the step therapy modality allows for tight control of product usage within any step therapy class of drugs. "This approach somewhat guarantees that patients will always receive the plan's preferred agent-resulting in cost control," Boone says. "Should a patient require a different agent because of failure of the preferred agent, the physician can always write for an alternative choice, and the plan then has the satisfaction of knowing that the increased cost was justified.
"Unlike locking out all but one product, the step therapy approach allows plans to say that they cover alternative drugs but simultaneously assures the plan that only patients who fail the preferred product will actually get an alternative," Boone continues.
Generic products are among the highly utilized therapeutic classes, Gilderman says. "The use of step therapy can mandate that generic products be utilized before a more costly branded product is prescribed," he says. "With the cost of branded products approaching $80 vs. $15 for generics, significant cost savings can be realized."