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Making Step Therapy Safe for Patients

Members of Congress are lining up behind step therapy reform.

A new bill introduced in the U.S. Senate would curb the health plan practice of requiring patients to try and fail an insurer-preferred drug before getting the one their doctor prescribed.  Under “The Safe Step Act of 2019” (S. 2546), group health plans would provide exceptions to step therapy requirements and a clearly defined appeals process – minimizing treatment delays for patients.  

The bipartisan bill is sponsored by Sens. Bill Cassidy, MD (R-La.), Doug Jones (D-Ala.) and Lisa Murkowski (R-Alaska).

Some “steps” are rooted in medical guidelines.  But insurers more often use step therapy as a cost-cutting tactic – driving patients to the medicine that’s least expensive for the insurer.  Clinicians and patients alike have attested to step therapy’s painful effect on patients.  The time-consuming process of getting the medicine the doctor actually prescribed can prolong painful symptoms, delay relief and even allow irreversible damage or disease progression.  Research confirms that step therapy can undermine treatment outcomes.  

Patient advocates applauded the senators’ efforts.  Angus Worthing, MD, of the American College of Rheumatology commended the bill’s sponsors “for recognizing that forcing patients to ‘fail first’ through harmful step therapy practices puts them at unnecessary risk, prolongs pain and discomfort, worsens patient outcomes and undermines the clinical judgment of medical professionals across the country.”

The bill follows H.R. 2279, the House of Representatives’ version of “The Safe Step Act.”  Introduced in April by Reps. Raul Ruiz, MD (D-Calif.) and Brad Wenstrup, DPM (R-Ohio), the House bill now boasts 99 cosponsors.

Meanwhile, several states, including Delaware, Georgia, Oklahoma, Wisconsin, Ohio, New York, Indiana, Missouri and Illinois, have also passed step therapy reform.  

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