Signals
1Explained
2ExplainedApr 26, 2026payer-policy · peer-reviewed · patient-advocacy
How payer step-therapy evolved from a cost tool into a sequencing rulebook
Step-therapy began as a way for payers to manage spend on competing biologics with similar efficacy. It has, over the past decade, become a de-facto sequencing rulebook that defines the order in which classes are tried regardless of which class fits the patient's phenotype best. The clinical and patient-experience consequences are larger than the cost-management origin would suggest.
AccessStep therapyBiologicsPayer
ExplainedApr 26, 2026peer-reviewed · FDA · guideline-bodies
COPD's biomarker problem and how the field is solving it
COPD has, until recently, been managed as a single condition with a stepwise pharmacological ladder. The arrival of biologics in COPD - and the subgroup-driven trial designs that supported their approval - has forced the field to confront a biomarker question that asthma resolved a decade ago: which patient, which mechanism, which therapy, and how do we know.
CopdBiomarkersBiologicsEosinophils