Each Medicare Part D plan possesses an approved list of pharmaceuticals known as a formulary. Within this formulary, various protocols apply to the medications the scheme includes. Step therapy is one such protocol. When you receive a prescription for a drug subject to step-therapy stipulations, you must engage in a specific procedure based on the type of medication you have been prescribed (e.g., generic, preferred generic, brand name, etc.). It’s common to find multiple drugs that are therapeutically similar, implying they have comparable effects but might contain different components. This is analogous to opting for a store-brand ibuprofen instead of the branded Motrin available at the pharmacy. This concept of variations extends to prescription medications too.
Under step therapy, beneficiaries are mandated to commence treatment with the drug that represents the greatest value — known as the initial step — and should only proceed to alternative medications, which might be pricier or pose greater risks (subsequent steps), if the need arises. The specific number of steps and the criteria they entail can differ across various drugs.
