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Medication Access Alert: Step therapy

Step therapy happens when a health insurance company decides which treatments it will cover for certain health problems, such as inflammatory bowel disease (IBD), and in what order.
If you are subject to step therapy, work with your health care provider to try to get the treatment that is best for you.

Tips for inflammatory bowel disease (IBD) patients on navigating health insurance step therapy policies

What is step therapy?

Step therapy rules may sometimes stop you from getting the medicine that your doctor recommends right away.

Your health insurance company may make you first try several different medicines for certain amounts of time, step by step, to see if they work well. It may be weeks or months before you can get the medicine your doctor originally prescribed.

What can I do?

New state laws may help. You and your health care provider may have the right to ask for an exception to, or special help with, your health insurance company’s step therapy rules, or for an override of those rules.

In states with step therapy laws…

If your health problem falls within one of the situations covered by your state’s law, you and your doctor can apply for an exception or an override of step therapy rules.

If you request an exception, and then don’t get an answer from your insurance company within a certain amount of time, often 72 hours, or 24 hours if it is an emergency, the treatment your doctor prescribed is automatically covered. You may also be able to appeal an insurer’s decision, if needed.

Is my state covered?

Check the list below to see if your state is covered. Don’t see your state? Check out your state’s health department website or visit www.gastro.org/step-therapy for updates and information.

ArkansasGeorgiaLouisianaMissouriTexas
CaliforniaIllinoisMaineNew YorkVirginia
ColoradoIndianaMarylandNew MexicoWashington
ConnecticutIowaMinnesotaOhioWest Virginia
DelawareKentuckyMississippiOklahomaWisconsin

Talk to your health care provider for more information about IBD, your treatment and whether step therapy could affect you.

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