Eighteen members of Congress, including Sen. Lisa Murkowski, R-Alaska, are supporting legislation that they say places reasonable limits on use of step therapy and works to improve access to safer and more transparent treatments for patients.
Step therapy, also known as fail first, is when a patient is required to try and fail on a lower cost drug before being allowed to access the drug originally prescribed by their physician.
The legislation, coined the Safe Step Act, would amend the Employee Retirement Income Security Act (ERISA) to require group health plans to provide an exception process for any medication step therapy protocol, tools used by health plans to control spending on a patient’s medications, and to help ensure patients are able to safely and efficiently access treatment. The bill does not ban step therapy, but instead places limits on its use and creates a clear process for patients and doctors to seek exceptions and accelerated approval if necessary.
“Patients and their families shouldn’t have to deal with a complicated process that threatens their health due to inefficient and burdensome requirements associated with step therapy,” Murkowski said, who introduced the legislation with Sens. Maggie Hassan, D-New Hampshire, Roger Marshall, R-Kansas, and Jacky Rosen, D-Nevada, along with 14 of their colleagues.
“No one should have to take medications that they have previously failed on or that their provider knows isn’t best treatment to comply with step therapy,” Murkowski said. “Current step therapy practices simply don’t work for many patients, and this bill works to address that very issue.”
The bill requires that insurers implement a clear and transparent process for a patient or physician to request an exception to a step therapy protocol.
The legislation also requires that group health plans grant an exemption if an applicant has already tried and failed on the required drug, if delayed treatment would cause irreversible consequences, the required drug would harm the patient, if the required drug would prevent the patient from working, or if the patient is stable on their current medication.
