What is a step therapy requirement?

Step therapy is a requirement set by some health insurance companies in Washington where a patient must try a more affordable treatment option before their insurance company will cover the cost for a more expensive one. It helps to protect patients from the high cost of medications and make sure they are receiving the most appropriate and cost-effective care. Step therapy usually requires a patient to try the least expensive, most clinically appropriate drugs first. For example, if a doctor prescribes a brand-name medication, a step therapy requirement may require the patient to try a generic version of that medication first. If the generic version does not work, then the insurance company will cover the cost of the brand-name drug. This helps to reduce health care costs by helping to ensure that the patient is using the most appropriate and cost-effective drugs. Step therapy requirements can vary by insurance company, so it is important to check with your insurance provider before taking a prescribed medication. If a patient is concerned about the cost of a medication, they can ask their doctor about step therapy to see if a more affordable treatment could be tried first.

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