Pharmacy Programs ‘Step Therapy’: What is it?

Most of us have heard throughout our lives two pieces of advice: “Don’t be afraid to try new things,”¬†and “When you find something that works, stick with it.” And for those of us seeking relief from chronic medical conditions like arthritis, asthma, hypertension, and others, combining these two pieces of advice can indeed be good medicine.

If you or a family member suffer from some kind of chronic condition, one that medical science is currently equipped only to “manage” rather than “cure,” you may have encountered the term “Step Therapy.” Step Therapy is defined as the practice of beginning pharmaceutical therapy for certain conditions with the most cost-effective and safest medications available, while stepping up to other more costly or risky therapies only if it becomes necessary. So in essence, Step Therapy is a practical application of both “trying new things” and “sticking with what works.”

The ultimate aim of Step Therapy is to improve or better manage the patient’s condition, while minimizing risks to the patient and controlling costs.

The “try new things” part — as applied within the FUSD’s Pharmacy Program’s Step Therapy plan — involves your doctor initially recommending or prescribing a “first step” medication. That “first step” may be an “over the counter” medication (actually prescribed by your doctor, which under the FUSD plan allows you to get it for only a $5 copayment) or a generic medication.

The “sticking with what works” part means that if you and your doctor agree that the prescribed over-the-counter or the generic works for you, stick with it. On the other hand, if the treatment does not manage the condition to you and your doctor’s satisfaction, your doctor can consider “stepping up” management of your condition to a different medication.

As always, ask your doctor a lot of questions about any medication prescribed. Make sure you understand the benefits and the risks. And if an OTC medication or a generic brings the relief you need, don’t be afraid to stick with what works.

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