Definitions for "Step Therapy"
Keywords:  pbm, formulary, costly, therapy, fail
Step therapy is a type of prior authorization. With step therapy, in most cases, you must first try certain less expensive drugs that have been proven effective for most people with your condition. For instance, some plans may require you to first try a generic drug (if available), then a less expensive brand-name drug on their drug list, before you can get a similar, more expensive brand-name drug covered.
requires a patient to try one drug before having access to another; that is, a non-preferred drug may be used only after the preferred drug has been used and has not been effective.
A requirement that certain drugs be used only after preferred "first line" drugs have been tried and shown to be ineffective or inappropriate for safety reasons. Part D drug plans may use step therapy requirements as part of their drug utilization management programs.