The Case for 'Safe' Step Therapy

This transcript has been edited for clarity.

I'm David Kerr, professor of cancer medicine at the University of Oxford. I'd like to talk today about a rather provocative article that was published recently in The New England Journal of Medicine.

It had a rather strong focus on the US health care system, as is so often the case with the New England Journal, but I think there are broader lessons that we might learn and apply to how we deliver cancer care in low-, middle-, and of course, high-income countries.

The article was about how medical care is delivered in the United States and a particular set of circumstances in their insurance system for delivering care called "step therapy." It was also about a current push for legislation around "safe step care," which is an interesting juxtaposition of words.

Step therapy is a utilization management strategy where insurers, or those who are in control of paying for healthcare, implement tiered treatment pathways.

Patients and their physicians need to seek approval for restricted — that is, expensive — therapies. But they can only do this if they've documented that they've tried the various different levels of simpler treatments before they can apply for, and one would imagine, be granted access to the expensive medicines.