Shalina Chatlani | (TNS) Stateline.org Cassidy Yermal, 32, began experiencing debilitating migraines when she was 17 years old. As a teenager growing up in northeastern Pennsylvania, she saw numerous neurologists and tried a variety of medications before finding one that provided relief.
In 2022, her new insurer asked her to prove it. Yermal now lives in Marlboro, Maryland, where she’s a sales representative at a furniture store. She is married and receives health care coverage through her husband’s employer.
In 2022, their new insurer told Yermal that it wouldn’t pay for her medication unless she tried several less expensive drugs first — or could prove that she already had. “I was like, ‘I don’t know why they’re asking for this documentation now. My other insurance company didn’t ask for it,’” Yermal told Stateline.
It was “really frustrating to me to have to dig up the kind of things that I knew didn’t work.” Millions of Americans have experienced similar frustrations under protocols known as step therapy, or fail-first policies. Insurance companies, and the pharmacy benefit management companies that handle prescriptions for them, often refuse to cover a specific drug until after the patient has tried cheaper alternatives.
Insurers argue that step therapy — taking drug treatment one step a time — prevents wasteful spending by directing patients to less expensive, but still effective, treatments. But patient advocacy groups and physicians say.
