Otherwise, known as a “fail first” protocol, step therapy is an insurance practice which mandates that patients try and fail medications preferred by their insurer before they can utilize treatments prescribed by their doctor. While the practice can sometimes be used to contain the costs of prescription drugs, it can also have serious negative impacts on patients, including delayed access to the most effective treatments, severe side effects, and irreversible disease progression.

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. 

The Safe Step Act (S.2903/H.R.5509) is a balanced public policy proposal that works to reform step therapy by:

• Establishing a clear exemption process. 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.
• Establishing an expedited review for at-risk patients. The bill requires a group health plan to respond to an exemption request within 72 hours in all circumstances, and 24 hours if the patient’s life is at risk.

"No two patient stories are the same and a one-size-fits-all treatment plan puts all people at risk. To prevent negative medical consequences, treatment should be recommended and prescribed by medical professionals in collaboration with the patient and not dictated by insurers. For these reasons, United Ostomy Associations of America Inc. (UOAA) stands in support of the Safe Step Act,” said UOAA President, Cheryl Ory. 

Please encourage your federal legislators to improve patient access and address step therapy reform by co-sponsoring the Safe Step Act.