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Commercial Step Therapy May Include Steps Beyond FDA Label
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Commercial Step Therapy May Include Steps Beyond FDA Label
Background Step therapy (ST) is a utilization management (UM) practice that “establishes a sequence of covered prescription drugs for a given medical condition.” The ST process requires a plan enrollee to try or “step through” one or more alternative medications for a period (e.g., three months) before a medication is covered by the plan. Commercial plans may note on their formularies or in formulary lookup tools that a drug requires ST (“labele…
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