13 Step Therapy Step therapy, or “fail first,” is an approach insurers use to reduce the costs they pay for medications. In step therapy, you are required to trylessexpensivemedications—and demonstrate that those fail to help you — before theyapprove coverage for more costly medications. Those in favor of step therapy argue that it helps to prevent doctors and patients from being influenced by marketing to use new, expensive, brand-name treatments when less expensive medicationswill provide equal benefit.Those against step therapy argue that it undermines patient choice and medical decision-making, and creates a burden for patients, physicians, and their staff as they navigate the process. There may be truth in both these viewpoints. However, the strongest argument against step therapy is that it can unnecessarily delay people from getting access to treatments that will work best for them. For this reason, step therapy is certainly not appropriate for a condition like MS, where delays in finding an effective treatment can have serious short- and long-term consequences. The goal of a disease-modifying treatment for MS is not to improve symptoms, but to prevent relapses and slow disease progression. In order to demonstrate that a treatment failed you, you would have to experience these serious consequences, which could mean that irreparable damage to the myelin and nerve fibers in your brain and spinal cord has occurred. While no one can guarantee a given treatment will work, if you and your doctor believe that a certain treatment has the highest likelihood of slowing down your MS, insurers should not limit your access to that treatment. What can you do? Let your legislators know how step therapy can hurt people with multiple sclerosis and similar conditions. Check out these resources: failfirsthurts.org This coalition provides more information on step therapy and an opportunity to join a network of patients and caregivers to take action on step therapy. steptherapy.com This site from the National Psoriasis Foundation contains information about legislative action on step therapy by state.