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Step Therapy’s Balancing Act – Protecting Patients While Addressing High Drug Prices

Document Type

Article

Publication Date

2022

Publication Title

New England Journal of Medicine

Abstract

In the absence of systematic drug-pricing reform in the United States, insurers frequently turn to utilization-management strategies to contain their rising prescription-drug expenditures. In response, state and federal policymakers have renewed their interest in legislative and regulatory actions targeting one of these strategies: step therapy. The debate regarding appropriate uses of step therapy reflects a tension between two important policy goals: safeguarding patients’ access to high-quality care and constraining spending on prescription drugs, including by limiting the overuse of costly medications with uncertain efficacy. In part because policymakers have failed to address the problem of high drug prices, controlling spending often falls to insurers, who have a business interest in keeping expenditures down.

Keywords

Step Therapy, Drug Prices

Publication Citation

Rachel Sachs & Michael Anne Kyle, Step Therapy’s Balancing Act – Protecting Patients While Addressing High Drug Prices, 386 New Eng. J. Med. 901 (2022)

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