News & Commentary

Step Therapy Works In Most Drug Classes

Step therapy (ST) is quickly becoming a popular method of controlling drug costs for commercial plans, Medicare, and Medicaid.

In fact, nearly 60 percent of commercial plans reported having one or more step-therapy programs in 2010, making it one of the most popular pharmacy benefit tools.

However, because of their quick adoption, adequate research has not been carried out to determine whether the programs have unintended consequences, such as medication noncompliance.

A study published in the Journal of Managed Care Pharmacy, reviewed 14 previously published studies of ST programs to determine clinical, humanistic, and economic outcomes.

Of the 14 studies, 7 were conducted in commercial plans and seven involved Medicaid. Five therapy classes, including antidepressants, antihypertensives, antipsychotics, nonsteroidal anti-inflammatory drugs (NSAIDs), and proton pump inhibitors (PPIs), were evaluated.

Taken as a body of work, the research has consistently found statistically significant drug cost savings for most of the therapy classes, except for the antipsychotic class. Savings result from greater use of first-line medications and from reduced medication initiation.

The research demonstrates that ST programs for therapy classes other than antipsychotics can provide significant drug savings through the greater use of lower-cost alternatives and, to a lesser extent, reduced drug utilization.

The researchers concluded that it is “unclear if this savings translates to antipsychotics, given the research conducted to date, but ST programs for NSAIDs and PPIs can provide significant drug savings without increasing the use of other medical services.”

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