Date: 11/16/2021

The Safe Step Act would require insurance providers to implement a clear and transparent process for a patient or physician to request an exception to a step therapy protocol. Upon an exception request, insurers are required to reply within 24 hours for emergency requests, or within 72 hours for non-emergency exception requests.

What is Step Therapy?

Step therapy is a tool used by health plans to control spending on patients’ medications. While step therapy can be an important tool to contain the costs of prescription drugs, in some circumstances, it has negative impacts on patients, including delayed access to the most effective treatment, severe side effects, and irreversible disease progression. 

Currently, when a physician prescribes a particular drug treatment for a patient, the patient’s insurance company may require them to try different medications and treatments before they can access the drug originally prescribed by their physician. 

This protocol is known as “step therapy” or “fail first.” Step therapy protocols may ignore a patient’s unique circumstances and medical history. That means patients may have to use medications that previously failed to address their medical issue, or – due to their unique medical conditions – could have dangerous side effects.

Take action and tell Congress to advance patient engagement by supporting the Safe Step Act of 2021!

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