Washington, D.C. (Sept. 26, 2019) – Patient advocates and health care provider groups from across the country today applauded the filing of bi-partisan legislation by Senators Lisa Murkowski, R-AK, Doug Jones, D-AL, and Bill Cassidy, MD, R-LA, which when passed, will offer common sense protections to ensure patients have timely access to the medications prescribed to them by their health care providers by putting parameters around an insurance industry practice known as “step therapy” or “fail first.”
Take action! Ask your member of Congress to support the Safe Step Act.
The ‘Safe Step Act’ (S.2546) is similar to legislation that was filed earlier this year (H.R. 2279) in the U.S. House of Representatives by Congressmen Raul Ruiz, MD, D-CA, and Brad Wenstrup, MD, R-OH, and offers many of the same patient protections that have been enacted in more than two dozen states across the country. H.R. 2279 has more than 90 co-sponsors in the House.
Both state and federal legislation is necessary in order to cover plans that are regulated by varying state and federal agencies.
“We are making real progress in the effort to ensure that patients have access to the right medicine at the right time, and without unnecessary and potentially harmful delays because of step therapy,” said Patrick Stone, vice president, government relations and advocacy, National Psoriasis Foundation. “With 27 states having passed step therapy reform, and bills in both the United States House and Senate, patients and doctors will be able to access needed treatments to manage their chronic conditions without delay.”
Under current step therapy protocols, insurance companies can force patients to try and fail alternative medications decided by the insurer, before covering the cost of the prescription that their doctor has prescribed. Patients can go weeks or months without proper treatment under step therapy, causing serious medical consequences, including worsening of disease and irreversible health effects.
“Time is of the essence when treating serious diseases such as cancer, and we have seen the effects of care delays on our patients, which include irreversible disease progression,” said ASCO President Howard A. “Skip” Burris III, MD, FACP, FASCO. “We’re pleased that the Senate has joined the House in working to pass legislation that provides critical guardrails to step therapy processes to help patients access potentially lifesaving medications in a timely manner.”
The ‘Safe Step Act’ does not ban the use of step therapy, but instead puts common sense parameters and reasonable timelines around the practice. The legislation will give doctors a transparent and standardized process to appeal step therapy requirements for patients needing a particular treatment.
Dr. Samir Shah, president of the Digestive Disease National Coalition, is a practicing gastroenterologist from Rhode Island. “I can’t even begin to tell you how many hours I, my colleagues and staff have to spend on the phone fighting these policies. Fail first protocols impede clinical decision making and delay necessary care. This bill works to strengthen the doctor-patient relationship and improve transparency over step therapy, which means I and clinicians across the country can spend more time with our patients and less time arguing over the phone with bureaucrats.”
“Step therapy poses a barrier to care for patients. When treating a patient with a chronic condition like inflammatory bowel disease, getting the patient the right medication at the right time is critical. The Safe Step Act will help providers protect their patients when subject to these protocols by ensuring common sense exceptions,” said Lisa Gangarosa, MD, chair of the American Gastroenterological Association Government Affairs Committee.
“I am not a guinea pig, and that is how I felt when the insurance company once told me which medication I could take in place of what my doctor had prescribed to me. This decision should be between my doctor and me, not the insurance company,” said Hannah Mitschele, a middle schooler from South Portland, Maine who lives with epilepsy. “I was so happy when the Step Therapy bill passed in Maine. It was always very scary for me to think the insurance company could possibly change my medication and I could start having seizures again. My next hope is that everyone in this country gets the same protections and access to the medications they need.
The ‘Safe Step Act’ will be referred to the Senate Health, Education, Labor and Pensions Committee and has been endorsed by the following organizations:
Alliance for Patient Access
American Academy of Dermatology Association
American Academy of Neurology
American Cancer Society Cancer Action Network
American College of Rheumatology
American Gastroenterological Association
American Society of Clinical Oncology
Association of Gastrointestinal Motility Disorders, Inc. (AGMD)
Chronic Disease Coalition
Crohn’s & Colitis Foundation
Digestive Disease National Coalition
Dystonia Advocacy Network
Dystonia Medical Research Foundation
Hemophilia Federation of America
International Foundation for Gastrointestinal Disorders
Lupus and Allied Diseases Association, Inc.
National Alliance on Mental Illness
National Eczema Association
National Infusion Center Association
National Organization for Rare Disorders
National Patient Advocate Foundation
National Psoriasis Foundation
Pulmonary Hypertension Association
The Marfan Foundation
US Hereditary Angioedema Association
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