What is "Step Therapy"?

When searching for drugs on Medicare's "Formulary Finder" tool, a few people asked that we explain the term "Step Therapy" listed under the heading of "Limitations/Restrictions". Step Therapy is a process whereby prescriptions are filled with an effective, but more affordable medication (Step 1). When appropriate, a more costly (Step 2) medication can be authorized if the Step 1 prescription is not effective in treating the condition.

In other words, Step 2 prescription drugs will not be covered until Step 1 prescription drugs are first tried.

Step Therapy is employed by some companies to help control Medicare Part D plan costs without jeopardizing the health of their plan participants.