Step Therapy
Step therapy, also known as 'fail first', is a practice used by health plans to control costs. Step therapy prevents patients from accessing a treatment prescribed by their physician by requiring them to try one or more alternative treatments first. Once those treatments have been proven ineffective or harmful to the patient, then they can step up to the treatment originally prescribed by the physician.
AiArthritis Position Statement On Step Therapy
AiArthritis supports federal and state protections for patients that limit health plans’ use of step therapy or “fail first” cost-containment protocols. For many patients, delaying access to the most clinically appropriate care can lead to adverse, severe, and more costly health outcomes, including irreversible disease progression.
Opportunity: Share Your Step Therapy Experience
Have you been forced to try and fail a different prescription before accessing the one prescribed by your doctor? Did this experience negatively impact your health?
Tell us about it - your lived experience can help us collect enough data to show decision makers (like legislators and insurance companies) this is a real issue that needs to be fixed!
Step Therapy Learning Resources
Discover Patient Journeys Through Step Therapy In Our Video Library!
The Patient-Instructed Video Library
The Patient-Instructed Video Library was created to help our community gain a deeper understanding of critical issues that affect access to health care. The goals of this initiative are to educate, inspire fellow patients to share their experiences, and empower our community to take action in addressing access-related challenges.
What is Step Therapy? (Jody's Perspective)
Jody AiArthritis Volunteer and person living with Psoriatic Arthritis, as she explains the definition of Step Therapy.
Step Therapy - Why Should Patients Care? (Jody's Perspective)
Jody discusses why patients should understand Step Therapy and how the process may impact your access to treatments prescribed by your doctor and based on your personalized needs.
Step Therapy - Why Should Patients Care? (Lisa's Perspective)
Lisa, AiArthritis Volunteer and person living with Rheumatoid Arthritis, explaining what Step Therapy is and how the process of delaying the treatment the doctor feels is best for you could lead to severe complications (like comorbidities) and, in turn, higher healthcare costs
Example of Step Therapy: (Leila's Perspective)
Leila, AiArthritis Education and Engagement Manager and person living with Lupus Nephritis and Sjogren's Syndrome, sharing an example of Step Therapy and how you can know if it's happening to you or someone else you know.
Step Therapy Patient Story: Abby's Perspective
Abby, an AiArthritis volunteer and a person living with Rheumatoid Arthritis and Spondyloarthritis, shares her struggles with step therapy. From advocating in Washington DC to confronting the rigid insurance system that stood between her and the right treatment.
Step Therapy Patient Story: Tiffany's Perspective
Tiffany, AiArthritis CEO and person living with non-radiographic Axial Spondyloarthritis, shares her journey through step therapy and utilization management. Tiffany opens up about her struggles with non-medical switching due to cost and the negative impacts this had on her health.
Step Therapy Patient Story: Jody's Perspective
Jody, an AiArthritis volunteer and person living with Psoriatic Arthritis, shares her journey and challenges faced with step therapy. Jody's journey reveals weeks of delays, denials, and even an incorrect review by a non-rheumatologist, causing her significant joint damage and reduced work hours.
Step Therapy Patient Story: Deb's Perspective
Deb, an AiArthritis volunteer and person living with Rheumatoid Arthritis, shares her story of step therapy and being denied access to a higher tier medication which she had successfully been on.
Class Is In Session! Step Therapy
About the Knowledge = Empowerment Public Policy Classroom: Patient instructors, including our CEO Tiffany, who has non-radiographic axial spondyloarthritis (nr-axSpA) and is a former award-winning college instructor, will collaborate with Class Discussion Leaders to host engaging webinars and AiArthritis Voices 360 Talk Show segments.
Step Therapy Class: Most have experienced this health insurance protocol that requires us to fail a cheaper drug before being allowed to access the one prescribed by our doctor. Learn more about this issue & what you can do if it happens to you. In collaboration with The National Psoriasis Foundation
How To Get More Involved!
Ready to deepen your involvement? Share experiences to support our fight for change with AiArthritis—join us for co-writing letters, virtual Field Trips, or become an inaugural AiAdvocate in our policy leadership program!
Patient Education - Legislator Education Sheet
A downloadable PDF is available on Step Therapy.
Join the Knowledge = Empowerment Program
A virtual, patient-led classroom approach designed to help patients understand legislative issues affecting treatment access and connect them with opportunities to advocate for change.
#WTHellth?!
Share your frustrations with the healthcare system using #WTHellth. Prefer privacy? Submit a written rant anonymously through AiArthritis’ RANT! program, selecting the #WTHellth category.