March 2018 Volume 16, Number 3 | |||||
Stepping into Lower Drug CostsStep therapy can save money but some say there can be a downside. Many insurance carriers are doing more than just asking plan members to use generics — they require members to start with a generic or less expensive medication before moving to the brand name drug prescribed by their doctors. This process, called step therapy, is a medical management tool many insurers have used for 17 years. According to the American Academy of Dermatology, 75 percent of large employers in 2014 offered employees plans that used step therapy. How it Works
When you or your employees have a prescription filled, the pharmacist checks a computer database to see if the prescription is a level (or tier) one, two or three. If the prescription is not a level one, you must start with level one before “stepping” up to a higher level. For instance, if you have acid reflux and your doctor prescribed a level three drug, the pharmacist is required to start you on an over-the-counter drug, such as Nexium 24-Hour. If that drug doesn’t work, then you would try the next level, such as Nexium. You might eventually reach level three — the level originally prescribed — if you really need it. The Benefits of Step Therapy
Insurance providers point out that level one drugs are proven therapies. Step therapy insures that doctors start with medications that have a long history of working before trying newer drugs. The Downside
Some patient advocacy groups say it’s unrealistic to think that all patients will respond well to level one drugs. They want more regulation of step therapy. And, while some patients respond well to the first medication level, some patients’ diseases get worse before they are stepped up to second tier drugs. What the Law Says
More and more states are enacting regulations to ensure that step therapy is used safely and effectively, including allowing exceptions to step therapy under certain circumstances when a doctor believes that lower levels will not work. So far, 14 states have enacted step therapy restrictions and about 12 more currently are introducing bills. |
|
This Just In ... Retirement Policy Tweaks Considered Stepping into Lower Drug Costs Ten Reasons to Motivate Employees to Use Their Employee Health Benefit Portal Kicking it Up a Notch — Retirement Contribution Limits Increased Ways to Proactively Combat Mental Health Issues in the Workplace
|
|||
|