science

Step therapy

Step therapy is a science topic covered in the lgStudy science library. This page brings together a partial reference excerpt, illustrations, worked examples, real-world applications and a short study plan, so you can understand Step therapy rather than just read about it. In short: Step therapy, also called step protocol or a fail first requirement, is a managed care approach to prescription. It is a type of prior authorization requirement that is intended to control the costs and risks posed by prescription drugs.

Key takeaways

Step therapy belongs to science; place it in that map before memorising details.
Learn the definition first, then one example that makes the definition concrete.
Connect Step therapy to a quantity you can measure, compute or draw — that is where exam questions come from.
Reproduce the core statement of Step therapy from memory before moving on to harder problems.

Reference excerpt

Step therapy, also called step protocol or a fail first requirement, is a managed care approach to prescription. It is a type of prior authorization requirement that is intended to control the costs and risks posed by prescription drugs. The practice begins medication for a medical condition with the most cost-effective drug therapy and progresses to other more costly or risky therapies only if necessary. The increase in prescription drug prices in the United States has increased the pressure on health care providers to keep down the cost of prescription medication while maintaining high levels of availability to the patient. The use of generic drugs whenever possible allows health care plans to pursue both goals effectively. Physicians and managed care providers may disagree on the proper step therapy, and patients are encouraged to become knowledgeable in managing their own care.

Opponents Opponents of step therapy, such as Fail First Hurts, have detailed the pitfalls of step therapy. "Fail First is used by health insurers to control costs. It is time-consuming from a physician and patient standpoint, is more expensive from a direct and indirect out-of-pocket cost perspective, denies patients the drugs they need when they need them, and allows payers to practice medicine without a license." They claim that it also has the following disadvantages:

Creating additional barriers, leading people to forgo needed medications Possibly causing patients' medical conditions to deteriorate, increasing the need for later medical intervention in the future, thus making patients require increasingly-costly medical care Increasing frustration and incidents of depression Increasing the risk of non-compliance and self-medication

See also Health care in the United States Prescription drug Prescription drug prices in the United States

References

Further reading The Academy of Managed Care Pharmacy - Hosting the Journal of Managed Care & Specialty Pharmacy The Academy of Managed Care Pharmacy's Concepts in Managed Care Pharmacy: Prior Authorization

Worked examples

Example 1 — a first encounter with Step therapy

Start with the simplest possible case. Write down what Step therapy claims or describes in one sentence, then invent the smallest concrete situation in which that sentence is true. In science, the smallest case is usually a single object, a single equation or a single measurement. Check that every symbol or term in your sentence has a meaning in that case.

Example 2 — changing one variable

Take the situation from Example 1 and change exactly one quantity: double it, halve it, or set it to zero. Predict what should happen to Step therapy before you calculate. Comparing your prediction with the result is the fastest way to find out whether you understand the idea or only the words.

Example 3 — an exam-style question

Typical questions about Step therapy ask you to (a) state it precisely, (b) apply it to given data, and (c) explain a limitation. Practise writing all three answers in under five minutes; the third part is what separates a full-mark answer from an average one.

Applications of Step therapy

In research: Step therapy appears in science research whenever the underlying quantities have to be modelled precisely. Papers usually cite it as a starting assumption and then explore where it breaks down.
In technology and industry: Engineering practice reuses Step therapy in design rules, simulations and safety margins. Knowing the idea lets you read a specification sheet and understand why the numbers look the way they do.
In the classroom: Step therapy is common in secondary-school and first-year university syllabi. It links to neighbouring topics Health care quality, Health insurance, Managed care, so understanding it makes those chapters shorter.
In everyday life: Look for Step therapy outside the textbook — in sport, cooking, traffic, electronics or the sky above you. An example you found yourself is remembered far longer than one you were given.

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How to study Step therapy in 20 minutes

Read the reference excerpt below once, without taking notes.
Close the page and write down what Step therapy means in your own words.
Compare your version with the excerpt and mark what you missed.
Work through the three examples above with pen and paper.
Explain Step therapy out loud to somebody else — or to Teacher Smith in the lgStudy chat.

Frequently asked questions

What is Step therapy in simple terms?

Why does Step therapy matter?

Because it connects several science ideas at once: it gives you a definition you can apply, a quantity you can calculate, and a way to check whether a result is plausible.

How should I study Step therapy?

Read the excerpt, restate it from memory, then work through the examples and applications listed on this page. The five-step study plan above takes about twenty minutes.

What does this page cover?

It gives you a compact reference excerpt plus original lgStudy explanations, examples, applications and study material on Step therapy.