Step Therapy

This topic has 1 reply, 2 voices, and was last updated 1 year, 4 months ago by Avatar aadoc.

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    We all know that Step Therapy for patients on large molecule drugs can have serious ramifications. This is a space to discuss methods to navigate and overcome these policies with various payers. Please feel free to share any specific instances of Step Therapy keeping a patient of the meds of their choice and the NICA Team will work to advocate on your patient’s behalf where appropriate.


    I have had some ridiculous step therapy requests recently; one PBM required that the patient fail a long list of “favored” medications for RA before they would approve a biologic. The list included penicillamine, oral gold and cyclopsporin A. I assume that they found a list of drugs used in 1980 and reprinted it. Interestingly, Penicillamine is only available as name brand Cuprimine, and according to epocrates costs $50,911.00 for 6 tablets. I should prescribe 3 months worth, and let them figure out how much it would cost….

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