Step Therapy: What “Fail First” Means and Why It Matters in Lung Cancer
August 5, 2026
Some insurance plans use a policy called step therapy, sometimes known as fail first. This means some plans may require you to try a lower-cost cancer therapy before they will cover the therapy your healthcare team originally recommended.
Step therapy is not new, but it is getting renewed attention because of recent changes to Medicare Part D could lead some Medicare prescription drug plans to rely more on tools like prior authorization (getting approval before a treatment is covered), formularies (the list of medications a plan covers), and step therapy. Health plans can use step therapy tools to help control costs by encouraging the use of less expensive or preferred medications before covering more expensive treatments.
The good news is that the step therapy policy does not appear to be widely used for many lung cancer drugs today. GO2 is closely monitoring these policy changes to help protect timely access to appropriate treatment. This is especially important in lung cancer because new therapies continue to be approved by the U.S. Food and Drug Administration (FDA), giving patients more treatment options. Lung cancer treatment is often guided by biomarkers. Biomarker testing results help your healthcare team determine which therapy is most appropriate for you, making timely access to that treatment important.
That is why GO2 supports ongoing legislative and policy efforts such as the Safe Step Act. If enacted, the legislation would help protect patients from unnecessary delays by making it easier to receive a timely exception when step therapy is not medically appropriate.
GO2 recently joined coalition letters, including efforts led by the MAPRx Coalition, expressing concern that recent changes to Medicare Part D payment could lead some Medicare prescription drug plans to rely more on tools like step therapy and prior authorization. These policies could make it harder to get the treatment your healthcare team believes is best for you.
For those interested in learning more, organizations like Aimed Alliance offer resources on step therapy policies, including state laws and patient rights.
GO2 will continue to monitor how these policies are implemented and advocate for approaches that protect timely access to the most appropriate care.
A lung cancer diagnosis can bring a lot of questions, emotions, and uncertainty. GO2 for Lung Cancer's free HelpLine connects you with trained specialists who can provide support, answer questions, and help you find resources along the way. Whether you're newly diagnosed, in treatment, or navigating survivorship, you don't have to face it alone.
Call us at 1-800-298-2436 or email support@go2.org to learn more.