Step Therapy

Step Therapy is a game insurance companies like to play because it MIGHT possibly save them some money. When a doctor prescribes a treatment for a pain patient, insurance companies often require trial of cheaper options which must fail before moving on to the next step. Often there are many steps placed between the patient and their doctor’s prescribed treatment. This fail first process has many challenges and pitfalls for patients and puts insurance companies in the role of treatment decision maker, instead of your provider. Read on to see how the game is played in our Step Therapy Poster Project.

iPain’s position

Step Therapy practices that go unregulated create additional barriers leading people in pain to forgo needed medications. This can cause pain patients to worsen and also increases the need for medical care in the future. Costing patients and insurance companies more in the long run. These delays in care increase frustration, anxiety and depression. When fail first policies come into play the risk of non-compliance and self-medication goes up.

  • Clinicians should be able to easily override protocols if they can document reasons for doing so.
  • Insurance companies should be encouraged to conduct research into the true costs of step therapy protocols, considering utilization of other medical services as well as their impact on the pain patient’s quality of life.
  • No person with pain should be required to try an inordinate number of ineffective treatments.
  • We supports policies that limit the ability of third party payers to mandate step therapy protocols for the treatment of chronic pain.

Step Therapy Awareness Video – iPain PSA Project

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Step Therapy Poster Project. – This poster explains the pitfalls of step therapy practices by insurance companies, and offers some solutions to level up with the insurance companies.


The International Pain Foundation (iPain) supports Fail First Hurts initiative.

The International Pain Foundation (iPain) is proud to support the Fail First Hurts initiative. Fail First legislation will prohibit health insurers from requiring a patient to try and fail medications before allowing the patient to have the medication prescribed by their doctor. The iPain strongly supports legislation which would also allow a doctor to determine the duration of any step therapy or fail first protocol. The International Pain Foundation addresses the problems of step therapy by specifically focusing on patients in pain to highlight the inadequacies of the practice because a pain patient can tell immediately whether a pain medication is working or not, and they should not be forced to stay on medicine which does not relieve their pain. The iPain adamantly believes that applying step therapy protocols rigidly to a pain patient is not in the patient’s best interest and simply creates undue challenges to pain patients. The iPain provides community based support services that address the immediate need of pain patients. Accordingly, beneficiaries include patients who are economically and socially affected by these invisible diseases. The iPain’s ultimate goal is to allow chronic pain patients the ability to perform their regular activities in the community and to bolster society’s ability to provide full opportunities and appropriate supports for its pain citizens. The iPain is supporting Fail First legislation to shed light on the unethical treatment of pain patients, especially women, minorities and economically disadvantaged patients, whom studies have shown are either disproportionately under treated, or go untreated for pain. The International Pain has a strong commitment to reducing health disparities in the communities we serve and we are extremely proud of supporting these crucial bills. For More on the Fail First Hurts Project! click here

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