What is Step Therapy and Should You Be Worried About It?

doctor holding white bottle of pills

By Melissa Haller Tanoko

Published On: Jun 6, 2022

Last Updated On: Sep 28, 2022

When you have eczema, the right medication can make a world of difference. But what if your insurance company won’t cover it unless you try a less expensive alternative first? This process is called step therapy – it’s when a doctor prescribes a specific treatment for a patient, but the insurance company denies coverage until the patient “steps” through a series of alternate treatments first. NEA is working to combat this roadblock by influencing insurance legislation on both the state and federal levels. You can help NEA right now – in as little as 30 seconds – by sending an email to your legislator and asking them to cosponsor a new law that will help people with eczema get the treatments they need.

What to do if you get stuck in step therapy

Patients may first realize that step therapy is impacting them when their prescription is denied by their insurance company. When faced with step therapy, some patients decide to pay for their medications out of pocket, while others give up on receiving the intended treatment altogether. Neither of these solutions is ideal. If you and your doctor believe a new medication may be denied on the basis of your insurer’s step therapy policies, you can talk to your doctor about prior authorization. This involves having your doctor’s office submit information about your medical history to the insurance company before sending in the prescription. 

Another option is to file an appeal. Appeals can be internal (made to the company) or external (made to state departments or the Department of Health and Human Services at the federal level). If you are starting out with this process, the first step is to file an internal appeal with the company. If that appeal is denied, you can then submit an external appeal.

What NEA is doing to help

NEA has supported legislative bills at the state and federal levels that require insurers to create step therapy policies that allow exceptions, are transparent and based on sound clinical evidence. If you are passionate about step therapy reform and would like to help promote it, consider becoming a NEA Advocacy Ambassador. And remember that in as little as 30 seconds you can add your voice to the growing chorus of people with eczema who are actively fighting to help people get the treatment they need the first time around.

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