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October 16, 2020

Step Therapy Can Lead to Higher OOP Costs for Crohn’s Disease Patients (Avalere)

Avalere assessed potential implications of step therapy on patients with employer coverage to examine total OOP and payer costs. Step therapy—also known as “fail first”—is a common form of utilization management that health plans use to control costs. Step therapy requires patients to try a preferred drug before gaining access to the drug prescribed by their provider.

In some instances, step therapy may provide patients with an effective generic or low-cost treatment option and can therefore be associated with lower patient OOP and insurer costs. In other instances, step therapy may require patients to try a preferred brand option due to considerations related to contracts and rebate negotiations. In those instances, step therapy could serve as an obstacle to getting the product that a provider has deemed most appropriate for their patient and may be associated with delayed treatment, poor patient adherence, or a negative clinical outcome that may cause increased overall costs. Read More >>

Filed Under: Advocacy, Protecting Patient Access to Integrated GI Care in the Independent Setting, Research, Resources

Member Spotlight

Allied Digestive Health is a gastroenterology and hepatology practice with more than 50 locations throughout New Jersey and New York, specializing in colon cancer screening, and the treatment of Celiac Disease, GERD, and IBD.

Learn more at:
www.allieddigestivehealth.com

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    Is your practice interested in promoting and preserving accessible, high quality and cost-efficient care in the independent GI medical setting? Contact us today about joining DHPA.

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