The Formulary Files

Step therapy works initially, but not for long

In a recent study, it was shown that step therapy may create barriers for members to receive medication, and ultimately result in higher medical utilization and costs.

That study, published in the American Journal of Managed Care, reports that employers who had implemented step therapy for angiotensin-converting enzyme inhibitors/angiotensin receptor blocker medications were compared with employers who had not implemented step therapy.

Tami L. Mark, PhD, MBA, director of analytic strategies at Thomson Reuters Health Care and lead author, says that “step therapy is becoming very common and there’s a need to evaluate what its impact is, and not assume what its impact might be.”

This study focused on all types of medical care utilization and spending — prior research has shown that drug costs decrease when a step therapy program was implemented.

The researchers reported an initial 7.9 percent reduction in days of medication supplied and an initial 3.1 percent reduction in costs for employers that used step therapy.

“We did find that patients discontinued their medication more so after step therapy was implemented,” says Mark. “There was a decrease in prescription drug costs in the step therapy group relative to the control group, although that effect diminished over time. Conversely, we found that emergency room visits and hospitalizations increased and that total medical care costs increased.”

Quarterly expenditures in the step therapy group were $99 more per user than in the comparison group after eight quarters.

Effects of step therapy on expenditures

Difference between step therapy plans and comparison plans in each quarter after start of step therapy

Source: Mark TL, Gibson TB, McGuigan KA. The effects of antihypertensive step-therapy protocols on pharmaceutical and medical utilization and expenditures. Am J Manag Care. 2009;15(2):123–131

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