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January 6, 2020

Tips for navigating step therapy

Learn more about “fail first” and state-specific laws.
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Step therapy is an insurance tool that requires patients to fail medications before agreeing to cover a health care provider’s initial treatment recommendation. It prevents the delivery of personalized patient care, increases administrative burden, and causes emotional and financial hardships for patients with inflammatory bowel disease.

How step therapy works:

  • Your patient is diagnosed with Crohn’s disease or ulcerative colitis.
  • You prescribe treatment A for your patient.
  • Your patient’s insurance company denies coverage for drug A and requires them to fail one or more drugs before covering your recommended treatment.
  • Meanwhile, you and your staff continue to be inundated with insurance paperwork and your patient’s health suffers.

More than a dozen states have implemented step therapy laws to provide patient protections. AGA is dedicated to helping health care providers navigate this challenging landscape and advocating for federal step therapy laws.

Learn more about step therapy, AGA’s advocacy efforts and how you can be your patients’ advocate at www.gastro.org/step-therapy.

This activity is made possible by support from Pfizer and Takeda Pharmaceuticals America, Inc.

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