What is a step therapy requirement?

A step therapy requirement is a health insurance policy in California that requires patients to try a cheaper, lower-cost treatment option before they can access more expensive treatments. This policy is in place to help keep healthcare costs low, by preventing the over-prescription of expensive treatments that may not be necessary. Step therapy requires that a patient use the cheapest treatment first, before progressing to higher-cost treatment options. For example, if a doctor prescribes an expensive medication for a patient, the health insurance company might require that the patient first try cheaper, lower-cost medications before they move on to the more expensive one. If the cheaper medications do not work, then the health insurance company will allow the patient access to the more expensive option. Step therapy is a relatively common policy for many California health insurance plans. It is important to note that the policy does not apply to all medications, and does not prevent the doctor from prescribing whatever treatment they deem necessary. It is simply a way for the insurance company to help manage healthcare costs.

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