Advocacy Day Speaking Points
Step therapy threatens patients’ access to treatment
What you need to know:
- Step therapy, also known as “fail first,” requires patients to try and fail one or more therapies before the insurer will cover the initial therapy prescribed by their health care provider.
Key arguments against step therapy:
- Negative impact on patient care: Step therapy can lead to a critical delay in obtaining the medicines needed for the best outcome, potentially resulting in irreversible disease progression, complications, hospitalizations or death.
- Undermines the physician-patient relationship. Physician-patient relationships are built on trust. Patients should have the confidence that their physician is making the best treatment recommendation based on their health situation, not based on what will be accepted or rejected by the insurer.
Lack of cost-saving evidence: There is no empirical evidence that supports step therapy as an effective practice to cut health care costs. In fact, due to the increase in hospitalizations from health care complications, it is not an effective cost saving policy.
Administrative burden: While some practices can hire full-time employees devoted to navigating this process for patients, many do not have the resources to devote to this administrative burden, forcing practices to split valuable time between providing patient care and managing administrative burdens.
What can you do next?
- Share a personal story of how step therapy in commercial plans negatively impact your patients.
Legislative ask: Cosponsor H.R. 2163/ S. 464, the Safe Step Act. This legislation provides common sense guardrails on existing step therapy protocols, including a clear and transparent appeals process. If the member of Congress is already a cosponsor, thank them.
