How to Get the Treatment You Need
If you’re navigating step therapy, being informed, organized, and proactive can make a real difference. Here’s what to do.
Understand your insurance formulary. Study your policy and learn which medications are covered — and which require step therapy or prior authorization. “Try your best to understand your insurance formulary,” Daveluy says.
Keep detailed records. Track every treatment you’ve tried, including dates, side effects, and results. “Keeping a diary can be helpful when documenting treatment failure,” Garshick says.
Work closely with your dermatologist. Your doctor can submit prior authorizations, write letters of medical necessity, and file appeals when needed. Stay on top of renewal dates, too. “Authorizations often need to be renewed each year, even when a treatment is working. That can also cause delays in care that result in flares,” Daveluy says.
Be proactive and persistent. Advocate for yourself, Garshick says. If something isn’t working, speak up early. And if a claim is denied, don’t stop there.
“You pay the insurance company, and they owe you a service,” Daveluy says. Patients can also call insurers directly to clarify requirements — or even file a complaint if they believe the process is unreasonable.
Request an exception when appropriate. In some cases, doctors can bypass step therapy requirements if a medication is medically necessary or more appropriate for your condition, Garshick says. This is especially the case “when disease severity or quality-of-life impact warrants it,” she says.
