These talking points explain that health plans and pharmacy benefit managers (PBMs) utilize independent Pharmacy & Therapeutics Committees, comprised of experts that include physicians, pharmacists, and other medical professionals to develop evidence-based guidelines used in drug management programs, such as step therapy, and assure that cost controls do not impair the quality of clinical care.

Step therapy requires an enrollee to try a medically appropriate first-line drug, typically a generic alternative to a branded product, when a new therapy is initiated. The prescriber is asked to consider ordering a therapeutic alternative. If that medically appropriate alternative was tried earlier and the patient did not achieve optimal outcome, the brand product is approved and dispensed.