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.