Biologics

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.