This content is for general informational purposes and does not constitute medical, legal, or financial advice. Healthcare rules and costs change annually. Last reviewed: January 1, 2026. Always verify current details with your insurer, employer, or a licensed healthcare navigator.
Step Therapy
An insurer's requirement to try lower-cost medications before approving a more expensive drug.
Full Definition
Step therapy (also called 'fail-first' policy) requires patients to try one or more less expensive, often generic medications before an insurer will approve coverage for a prescribed brand-name or specialty drug. The rationale is cost savings; the criticism is that it delays optimal treatment and places administrative burden on patients and physicians. Many states have enacted step therapy reform laws that require insurers to grant exceptions for patients who have already tried and failed a step therapy drug, or for whom a step therapy drug would be contraindicated. Exceptions can be requested by the prescribing physician.
Real-World Example
Your doctor prescribes a brand-name biologic for your rheumatoid arthritis at $3,000/month. Your insurer requires step therapy — you must first try two less expensive DMARDs for 90 days each. If they fail, the insurer will cover the biologic. Your doctor files a step therapy exception citing previous treatment failures.
Related Terms
Was this helpful?