What is a step therapy requirement?

A step therapy requirement is a type of procedure that is used for health insurance coverage in Maryland. It requires a patient to try one or more forms of therapy before proceeding to a higher-cost treatment. Step therapy is based on a belief that cheaper treatments should be tried first, and more costly treatments should be used only if the cheaper treatments do not work. In Maryland, step therapy requirements are used for a variety of medical services, such as prescription drugs, mental health services and physical therapy. Generally, a health insurance company will require the patient to try a certain number of lower-cost treatments before approving the more expensive one. For example, a patient may have to try one or more lower-cost medications for their condition before the health insurance company will cover a more expensive drug. Step therapy can be beneficial because it may allow a patient to receive a lower-cost treatment that is just as effective as a more expensive one. However, step therapy can be a frustrating process for a patient, as it may cause delays in receiving treatment. In addition, step therapy may not be effective for some conditions, and the patient may end up having to go through the steps without benefitting from them. Overall, step therapy requirements are used in Maryland to make sure that health insurance companies cover the most cost-effective treatments available. It can be beneficial, but it has its drawbacks as well. It is important to talk to your health care provider if you have any questions about how step therapy may apply to your treatment plan.

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