Step therapy, also known as “fail first,” is a technique used by insurers that requires patients to try lower-cost medications before covering more expensive treatments, despite a physician’s recommendation.
This process forces patients to wait weeks, months or years while facing a long list of potentially dangerous side effects before being approved for medication prescribed by their doctor.
Here’s the good news: Legislation is being proposed at the Congressional level and in many states, including New Jersey and California that would fight this discriminatory practice by ensuring doctors have a path for advocating on patients behalf for the treatments they need.
Most importantly, the newly introduced federal Safe Step Act (S.464 and H.R. 2163) would put transparency guidelines in place to prevent inappropriate use of step therapy. According to Policy & Medicine, the legislation includes five situations in which a patient would be exempt from step therapy policies pending that patient meets any of following guidelines:
- If the patient has already tried and failed the insurer-preferred drug
- If delayed treatment will cause irreversible consequences
- If requiring the insurer-preferred drug will cause harm to the patient
- If the required drug will prevent a patient from working or fulfilling activities such as eating, grooming, dressing, bathing and other Activities of Daily Living as defined by the Centers for Medicare and Medicaid Services (CMS)
- If the patient is stable on the prescription drug selected by their provider, and that drug has been covered by their previous insurance plan.
Implementing these guidelines would give patients the care they deserve, ensuring proper and timely treatment. Help us protect doctor-prescribed treatments and protect patient access to care by stopping the use of step therapy practices across the country and passing the Safe Step Act federally.
Send a note to U.S. senators voicing your support for S.464 to help stop step therapy today and join us for a social flash mob on May 11 by sharing this graphic with the #stopsteptherapy on your social networks!