Step therapy, which requires those seeking prescription medication to try less expensive drugs before more expensive options are approved, is sometimes imposed by health insurers as a cost control strategy.
This requirement, also known as a “fail first” protocol, is commonly imposed in cases when lower-cost generic drugs are available (relative to name brand prescriptions) or when clinical guidelines recommend a specific sequence of medications. In Missouri, patients may currently seek to override step therapy requirements if they have already tried a prescription ordered by the insurer and demonstrated its lack of efficacy or a negative side effect.
HB 751 would require that step therapy protocols be based on clinical practice guidelines that are developed by a multidisciplinary panel of experts using published research and public review to inform them. This bill would also expand the criteria that would allow a patient to seek to override a step therapy requirement in cases where the suggested prescription is likely to cause harm or is not in the best medical interest of the patient.