AGA Family of Websites: Gastro.org
AGA Journals
AGA Journals
AGA University
AGA University
AGA University
AGA Research Foundation
AGA University
AGA Community
AGA University
AGA Job Board
A mid adult male doctor sits at a table across from an unrecognizable patient.  He holds up a prescription bottle as he explains the benefits and risks of a new medication.
February 25, 2020

Help your patients succeed — not fail first

Take action on AGA’s step therapy website.
Share on facebook
Share on twitter
Share on linkedin
Share on email

Step therapy, “fail first,” treatment circumvents your expertise by requiring patients to fail one or more medications before covering your original prescription. By delaying access to effective treatments, insurers are putting your patients’ health at risk. With the increase of biologics to treat diseases like inflammatory bowel disease (IBD), more and more patients with digestive diseases are subject to this policy.

What are we working towards? 

We believe patients should be given a clear, equitable and transparent appeals process when subjected to step therapy protocols. We support the Safe Step Act — federal legislation which does not eliminate the use of step therapy but aims to alleviate patient and provider burden by:

  • Making information about the appeals process readily available on the health plan’s website, including the exception requirements and any necessary forms and contact information.
  • Granting patient exceptions to step therapy under critical circumstances (e.g. treatment is contraindicated, expected to be ineffective or cause an adverse reaction).
  • Expediting care by requiring a timely decision for appeals — 72 hours or within 24 hours, if life threatening.

It’s not too late to advocate.

Explore tips for navigating step therapy, contact your member of Congress and see if your state offers patient protections at www.gastro.org/step-therapy.

This activity is made possible by support from Pfizer and Takeda Pharmaceuticals America, Inc.

Discussion Icon

Discuss this news

Share this article in the AGA Community, your member-only platform for sharing your thoughts and ideas with your colleagues.

Not a member? Join AGA.

By using this site, you agree to our updated Privacy Policy.