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December 11, 2019

Watch your step (therapy) — understanding ‘fail first’

Learn about the step therapy protocol and state specific legislation that protects patients.
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Sometimes known as ‘fail first,’ step therapy is a tool used by insurance companies that requires patients to fail medications before agreeing to cover a health care provider’s initial treatment recommendation.

Largely affecting patients with inflammatory bowel disease (IBD), step therapy focuses on the use of insurer-preferred treatments rather than effective, patient-centric therapies. In addition to causing many patient hardships, this protocol allows insurance companies to come between the provider-patient relationship and dictate a patient’s course of treatment.

To help clinicians navigate this challenging landscape, AGA is pleased to offer a new step therapy webpage that details the step therapy protocol and opportunities to advocate for patient protections. Additional education modules — including videos, podcasts and other resources — are also available for several states that have implemented safe step therapy laws, including Illinois, New York and Texas.

Visit the Navigating State Step Therapy Laws program page to learn more:

  • What is the step therapy protocol?
  • How does step therapy impact a health care provider’s ability to provide patient care?
  • Which states have implemented step therapy laws?
  • How do state step therapy laws provide physician rights and patient protection?
  • Tips to share with your patients.
  • What are AGA’s advocacy efforts — and how can I help?

Education modules for additional states will be available in early 2020.

AGA’s Navigating State Step Therapy Laws program is funded by an unrestricted educational grant from Takeda and Pfizer.

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