ACG Note: Prior authorizations and step therapy requirements continue to harm patient care and increase administrative burdens among GI practices. Step therapy entails the "fail first" drug therapy requirements in which patients are forced by insurers to try to fail with one or more medications before the cost of the medication originally prescribed will be covered. Ironically, step therapy often leads to unnecessary increases in health care and drug costs. That is why ACG continues to fight to protect the sanctity of the patient-provider relationship, as the prescribing clinician and patient are best suited to determine the correct course of treatment.