Prior authorization of drugs, diagnostic testing, or other medical services “is intended to ensure that health care services are medically necessary by requiring providers to obtain approval before a service or other benefit will be covered by a patient’s insurance.” In reality, it is a cost-control measure by insurance companies. It doesn’t mean you can’t get the care, just that you must jump through several hurdles first.
Step therapy
Step therapy generally refers to trying one medicine after another, in order to get the best response for your patient. Most insurance companies believe that the lowest cost is the "best" approach. But an often-overlooked issue for both physicians and their patients is stepping down treatments, or eliminating unnecessary meds that are no longer necessary or "align with patient interests."