Does a 'One-Size-Fits-All' Formulary Policy Make Sense

Over the last decade, insurers have increasingly used step therapy or “fail-first,” policies as a strategy to contain pharmaceutical costs. Step therapy requires patients to begin treatment for a medical condition on a typically less expensive drug, and only progress to more costly second-line drugs when the first-line therapy becomes ineffective or inappropriate. Step therapy shifts clinical decision-making away from physicians and toward centralized policies that define treatment steps for patient populations based on the potential for more cost-effective care. The rapid growth in the use of step therapy policies in recent years indicates a misunderstanding about the direct and indirect harms of this “one-size-fits-all” approach.

 
 
  • Authors: A Chung, J MacEwan, and D Goldman
  • Publication Year: 2016
  • Source: Health Affairs Blog