Step therapy is an insurance cost-saving strategy enacted by private health plans and private Medicare drug plans. Before a plan will cover some (generally more expensive) drugs, they require you to try other (generally less expensive) drugs that also treat the condition. Sometimes referred to as “fail-first” policies, patients must fail on these cheaper or preferred medications, before their insurer will cover their doctor prescribed medication. The bleeding disorders community maintains that step therapy should not be used when prescribing clotting factor. Biologics products are not therapeutically equivalent and should be prescribed by hemophilia-specialists who have a strong relationship with their patients.

For bleeding disorder patients, the consequences of a treatment “failure” are extremely serious. The risks of a major bleed, or of cumulative damage from repeated bleeds, are too high to expose hemophilia patients to potentially ineffective treatments, or to delay their access to the therapies prescribed by their doctors.

HFM is working closely with the American Autoimmune Related Disease Association to share information and resources with patients and doctors. To learn more about this step therapy initiative, visit www.letmidoctorsdecide.org.