What is step therapy, and what is a common strategy patients and physicians use to challenge it?

Step therapy (also called fail-first protocols) is an insurer cost-control tool that requires patients to try and fail on cheaper alternative treatments before the plan will cover a physician's preferred treatment. For medications, this might mean trying a generic drug first even when a physician believes a specific brand-name drug is more appropriate. Physicians can request step therapy exceptions by documenting that the required alternatives are contraindicated, are expected to fail based on the patient's history, or have already been tried without adequate effect. As of 2023, all 50 states have enacted some form of step therapy override legislation for state-regulated plans.