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Evidence for Step Therapy in Diabetic Macular Edema

List of authors.
  • David C. Musch, Ph.D., M.P.H.,
  • and Emily Y. Chew, M.D.

Step therapy is a treatment approach often required by health insurers to control costs. It involves treating first with a lower-cost medication and, only if that proves ineffective, switching to another, more costly medication. Although step therapy is commonly applied in treating hypertension, diabetes, cancer, and other conditions, concerns regarding its potential for long-term harm to the patient have led some to view it as “fail first” therapy.1,2 One valid criticism of step therapy is a lack of an evidence base for its efficacy and safety. In this issue of the Journal, Jhaveri, Glassman, and colleagues3 describe a rigorous trial . . .

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Funding and Disclosures

Disclosure forms provided by the authors are available with the full text of this editorial at

This editorial was published on July 14, 2022, at

Author Affiliations

From the Department of Ophthalmology and Visual Sciences, Medical School, and the Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor (D.C.M.); and the Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD (E.Y.C.).