Step Therapy

Step therapy, or “fail first”, is a process that requires individuals who have been prescribed certain medications to trial, and fail one or more medications preferred by the insurer, before receiving the medication preferred and prescribed by their physician. 

Treatment options for epilepsy are highly individualized and specific to each patient, the seizure type being treated and the response to therapy. All of this must be considered in conjunction with the patient’s overall health status.  The response to anti-epileptic drugs (AEDs) can be different for each person.  Maintaining excellent seizure control with minimal side effects requires careful evaluation and monitoring by both the physician and patient. To change, limit, or deny access to medications could be extremely dangerous. People living with epilepsy who have their medications switched, or who experience a delay in accessing their medication due to onerous step therapy requirements, are at a high risk for developing breakthrough seizures and related complications.  

Another concern is that step therapy also significantly increases medical costs related to preventable seizures. Step therapy contributes to lost wages and productivity, not just for the individuals living with epilepsy but also their families and communities. 

EFNE and the national Epilepsy Foundation oppose step therapy and similar policies intended to restrict access to physician-directed care that unnecessarily prolongs ineffective treatment, and prevents individuals from immediately starting the treatment their practitioners think will be best to assist in controlling their seizures. 

View the national Epilepsy Foundation full position statement here:

To learn more about National Conference of State Legistatures Resource on Epilepsy Drug Substitution Laws and Legislation visit:

To learn more about current legislation and bills being tracked by the epilepsy foundation visit: