Support the Safe Step Act

Lend your voice to support the The Safe Step Act of 2021 – S. 464/H.R. 2163

The Safe Step Act of 2021

The Safe Step Act amends the Employee Retirement Income Security Act (ERISA) to require a group health plan to provide an exception process for any medication step therapy protocol.

S.464 is sponsored by Senators Lisa Murkowski (R-AK), Margaret Hassan (D-NH), Bill Cassidy (R-LA), and Jacky Rosen (D-NV). The House companion bill, H.R. 2163 is led by Representatives Raul Ruiz (D-CA-36), Brad Wenstrup (R-OH-2), Lucy McBath (D-GA-6), and Mariannette Miller Meeks (R-IA-2).

The Safe Step Act would require insurance providers to implement a clear and transparent process for a patient or physician to request an exception to a step therapy protocol. Upon an exception request, insurers are required to reply within 24 hours for emergency requests, or within 72 hours for non-emergency exception requests.

Patients will be granted an exception if the patient has already tried the required treatment and it was discontinued due to lack of efficacy, if treatments are expected to be ineffective, if treatments are contraindicated or will likely cause an adverse reaction or harm to the patient, if the treatment has or will prevent the patient from fulfilling their responsibilities at work or performing daily living activities, or if the patient is stable with their current treatment that was covered by their previous insurance plan.

What is Step Therapy?

Step therapy is a tool used by health plans to control spending on patients’ medications. While step therapy can be an important tool to contain the costs of prescription drugs, in some circumstances, it has negative impacts on patients, including delayed access to the most effective treatment, severe side effects, and irreversible disease progression. 

Currently, when a physician prescribes a particular drug treatment for a patient, the patient’s insurance company may require them to try different medications and treatments before they can access the drug originally prescribed by their physician. 

This protocol is known as “step therapy” or “fail first.” Step therapy protocols may ignore a patient’s unique circumstances and medical history. That means patients may have to use medications that previously failed to address their medical issue, or – due to their unique medical conditions – could have dangerous side effects.

Take action and tell Congress to advance patient engagement by supporting the Safe Step Act of 2021!


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