Step therapy

Step therapy requires you to try one or more medicines the plan prefers before it will cover the one your prescriber originally chose. It is sometimes called fail first, because coverage for the second option typically depends on the first not working well enough or not being tolerated.

The exception most people don’t know about

Plans generally have a process for skipping a step. It commonly applies where you have already tried the preferred medicine — including under a previous insurer — or where trying it would be medically inadvisable.

That history is the part that gets lost. If you tried something two plans ago, the current plan may have no record of it. Pharmacy records, prior authorization numbers, and notes from the prescribing office are what turn “we have no record” into a documented step already taken.