Traditional step care protocols, whereby patients are required to try an older generation agent prior to obtaining approval for reimbursement of a newer one, have largely disappeared.
Currently, it is more common for payers to designate one or two preferred pharmaceuticals chosen from the newer agents. Patients must first experience a treatment failure on a preferred agent prior to being reimbursed for a non-preferred agent.
- These practices may contribute to the perception that access is too cumbersome.
- These practices may require switching among pharmaceutical agents within a given class (e.g., SSRIs).