Pharmacy Billing and Reimbursement Practice Test

Step therapy is a managed care process used by insurers to control prescription drug costs while ensuring patients receive necessary treatments. It requires patients to try one or more less expensive medications before moving on to higher-cost treatments. This approach promotes the use of generic and more affordable options, which can reduce overall healthcare expenses. If the initial treatments do not prove effective or if the patient experiences intolerable side effects, the healthcare provider may then seek authorization for a more expensive medication.

This approach encourages trial of cost-effective therapies first and supports the rationale behind many insurance plans seeking to ensure that premium pharmaceuticals are reserved for situations where more affordable options are ineffective. Consequently, this method aims to balance patient care with responsible spending in the healthcare system.