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FL Blue: Steps Keep Quality, Costs In Check

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

A subject that is receiving attention from Florida Legislators this session relates to the use of pharmaceuticals and how those prescription drugs are provided to patients.

A topic of particular interest is step therapy, where patients are prescribed historically proven drugs that are both medically effective and cost effective before “stepping up” to more expensive drugs (sometimes name brands).

At Florida Blue, we advocate for the use of clinically proven treatments that benefit our members. However, we recognize that there are clinical situations where historically effective treatments may not be appropriate. In those cases, we quickly move to provide our members access to other drugs that are clinically approved.

Nationally recognized experts have designed step therapy guidelines based on medical evidence. In fact, the Centers for Medicare and Medicaid Services (CMS) has reviewed step therapy protocols and accepts its use for its health care plans.

Step therapy is a medically accepted procedure that provides high-quality treatment and more affordable costs for our customers. The rising cost of prescriptions is having a significant impact on the health care system, forcing individual health care consumers, employers and employees to pay more for treatments, which can raise the price of insurance and individuals’ out-of-pocket costs.

The key to maintaining and optimizing health is for patients to take their prescriptions on a regular basis.

Today, one-third of prescriptions go unfilled. Individuals who do not take their medications on a regular basis for chronic diseases, like diabetes and high blood pressure, are likely to be sicker, suffer from more complications, and have higher mortality rates. This problem, known as non-adherence to prescription drugs, has been estimated to cost the U.S. health care system between $100 billion and $289 billion annually.

Research shows that the lower the cost of prescriptions, the more likely it is that patients will take the medications as prescribed.

Over the past month, Tallahassee lobbyists sent mailers to Florida residents, encouraging them to contact their legislators about medical care and the use of step therapy and other clinically proven treatment options.

What the special interest groups do not realize is that many legislators are already well aware of and engaged in discussions around these issues. In fact, many are standing with consumers on the proper side of the discussion, fighting to protect your rights to choose the most cost-effective quality health care that suits your needs.

Residents of Florida should be proud of their legislators’ support of maintaining the highest quality in our health care system, at the lowest possible cost, for Florida families.


Jannifer Harper, M.D.

Vice President and Chief Medical Officer, Florida Blue


Scott McClelland, Pharm. D.

Senior Director of Pharmacy Operations, Florida Blue