Which formulary strategy uses a stepwise approach to drug therapy?

• A. Tiered copays
• B. Step therapy
• C. Prior authorization
• D. Generic substitution

Answer: (B)

Step therapy is a formulary strategy that enforces a stepwise approach to treatment. Patients start with a preferred, typically lower-cost first-line medication, and only move to a more advanced or costly therapy if the initial option doesn’t achieve adequate control or isn’t suitable. This creates a systematic progression: try the most cost-effective option first, then escalate as needed. For example, in hypertension management, a plan might require starting with a generic thiazide diuretic; if blood pressure isn’t controlled after a trial period, the clinician can add another agent or switch classes. The other options serve different purposes: tiered copays adjust out-of-pocket costs by drug tier, prior authorization governs whether a drug gets coverage through an approval process, and generic substitution replaces branded drugs with generic versions without prescribing a sequence of therapies.