AHIP Practice Exam

What is "step therapy" in the context of Medicare prescription drug plans?

1. A requirement to use expensive drugs first

2. A protocol to switch medications frequently

3. A method using lower-priced drugs before trying more expensive options

4. A strategy for emergency room prescriptions only

The correct answer is: A method using lower-priced drugs before trying more expensive options

In the context of Medicare prescription drug plans, "step therapy" refers to a protocol where patients are required to try less expensive medications before progressing to more costly alternatives. This practice is designed to manage healthcare costs while ensuring that patients receive effective treatment. By starting with lower-priced medications, healthcare providers can determine if these initial treatments are sufficient for the patient's condition. If the patient does not achieve the desired results from these initial options, they can then "step up" to more expensive therapies. This method is beneficial because it encourages the use of generic or lower-cost drugs that have been proven effective for many conditions, thus helping to control spending for both the patient and the insurance plan. It also reflects an emphasis on patient safety and effective management of drug therapies, as not every patient requires the most expensive medication to effectively manage their health conditions.