What is Step Therapy?

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  • Written By: Mary McMahon
  • Edited By: O. Wallace
  • Last Modified Date: 31 December 2019
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The term “step therapy” is used in different ways. In most cases, it refers to a protocol instituted by insurance companies with the goal of cutting costs, in which patients are required to try generic medications before using brand name drugs. The term may also be used to refer to a particular approach to psychotherapy, in which the patient moves through a series of steps to address an emotional issue, rather than trying to confront the issue as a whole from the first day of therapy.

In the sense of a restriction on a pharmaceutical plan, when a drug is prescribed to a patient, the patient must first try a generic version, if it is available, in step one. If the generic drug is not effective, the patient will receive authorization to use a brand name drug, in step two. This type of prescription policy is also known as a fail first plan, referencing the idea that the patient must first fail on the generic drug before authorization for a more expensive branded drug will be given.


Insurance companies claim that step therapy helps them save costs, because they only spend money on more expensive drugs when these drugs are needed by the patient. Generics are supposed to be pharmaceutically equivalent, so these plans should not pose a risk to the patient, and their significantly lower cost makes it easier for an insurer to cover prescriptions. In practice, patients sometimes find that they have difficulty getting authorization for step two drugs without considerable support from a physician.

In the sense of psychotherapy, step therapy involves working with the patient through a series of steps. Step therapy may be conducted alone, as family therapy, or in group therapy. The 12 step programs utilized to address addiction are an example of step therapy, and there are numerous other approaches to this therapeutic technique. In all cases, the goal is to gradually introduce concepts and issues so that the patient does not become overwhelmed.

The concept of steps is also a key part of physical therapy. When patients enter physical therapy to recover from injuries or address congenital abnormalities, they cannot perform at their peak on the first day, and if they are pushed too hard, they may be prone to failure as a result of physical and emotional strain. By slowly building up the patient's strength and confidence, a physical therapist can introduce increasingly more challenging physical therapy activities which will help the patient recover over a prolonged period of time. This type of step therapy is tailored to the individual needs of the patient for best results.



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