Step Therapy
Step Therapy is an approach used by insurance companies and healthcare providers to manage prescription drug costs and ensure patient safety. It requires patients to try less expensive medications first before "stepping up" to more costly alternatives. Think of it like climbing a ladder: patients start with the most cost-effective treatment (usually generic drugs) and only move up to more expensive options if the initial treatment doesn't work. Pharmacists and healthcare providers often need to understand and work with Step Therapy protocols as part of their daily responsibilities in managing patient care and insurance requirements.
Examples in Resumes
Managed Step Therapy protocols for 200+ patients in retail pharmacy setting
Developed Step Therapy guidelines for specialty medications
Successfully navigated insurance Step Therapy requirements for critical care medications
Implemented Step Therapy Protocol management system for pharmacy team
Typical job title: "Pharmacy Professionals"
Also try searching for:
Where to Find Pharmacy Professionals
Professional Organizations
Job Boards
Online Communities
Example Interview Questions
Senior Level Questions
Q: How would you handle a situation where a patient's doctor is requesting to bypass step therapy requirements?
Expected Answer: A senior pharmacist should discuss the formal exception process, documentation requirements, communication with insurance providers, and understanding of medical necessity criteria. They should also mention patient advocacy while maintaining compliance with regulations.
Q: How do you stay current with changes in step therapy protocols across different insurance providers?
Expected Answer: Should describe systematic approaches to tracking updates from major insurance providers, implementing training for staff, and maintaining current documentation of protocols. Should mention specific resources and professional networks used for updates.
Mid Level Questions
Q: Explain how you would educate a patient about step therapy requirements for their prescription.
Expected Answer: Should demonstrate ability to explain complex insurance requirements in simple terms, show knowledge of common step therapy medications, and describe how to guide patients through the process while maintaining positive customer service.
Q: What documentation do you maintain for step therapy cases?
Expected Answer: Should discuss tracking previous medication trials, maintaining records of authorization attempts, documenting communication with providers and insurers, and ensuring proper storage of patient information.
Junior Level Questions
Q: What is step therapy and why is it used?
Expected Answer: Should be able to explain the basic concept of trying less expensive medications first, understand the cost-saving purpose, and describe common scenarios where step therapy applies.
Q: How do you identify when a prescription requires step therapy?
Expected Answer: Should know how to check insurance requirements, recognize common medications subject to step therapy, and understand basic process for verifying coverage.
Experience Level Indicators
Junior (0-2 years)
- Basic understanding of insurance requirements
- Ability to identify step therapy medications
- Basic patient communication
- Documentation procedures
Mid (2-5 years)
- Managing step therapy protocols
- Insurance authorization processes
- Patient education and counseling
- Provider communication
Senior (5+ years)
- Complex case management
- Staff training on protocols
- Policy development
- Insurance negotiation
Red Flags to Watch For
- Unfamiliar with major insurance providers' requirements
- Poor understanding of prescription drug tiers
- Lack of experience with prior authorization processes
- Weak patient communication skills
- No knowledge of documentation requirements
Related Terms
Need more hiring wisdom? Check these out...
How Collaborative Goal Setting Transforms Team Culture
Micro-Internships: The Game-Changer in Project-Based Learning
Navigating Compliance: Structuring On-the-Job Training in Regulated Industries
