Senate Introduces Bi-partisan Step Therapy Patient Protections

Portland, Ore. (September 26, 2019)—The National Psoriasis Foundation, NPF, applauds Senator Lisa Murkowski (R-AK), Senator Doug Jones (D-AL), Senator Bill Cassidy (R-LA), Senator Margaret Hassan (D-NH), Senator Cindy Hyde-Smith (R-MS), and Senator Jacky Rosen (D-NV) for introducing the Safe Step Act. This legislation amends the Employee Retirement Income Security Act (ERISA) to require a group health plan (or health insurance coverage offered in connection with such a plan) to provide a robust exception process for step therapy protocols.

Step therapy is a tool used by health insurance providers to control spending on patient’s medications. While step therapy can be effective in containing the costs of prescription drugs, in some circumstances, it can have a negative impact on patients including delayed access to the most effective treatment, severe side effects, and potentially irreversible disease progression.

Currently, when a health care provider prescribes a treatment, the patient’s insurance company may require them to try and fail on different treatments before they can access the one originally prescribed by their health care provider. This protocol is known as “step therapy” or “fail first.” These protocols do not consider a patient’s unique circumstances and medical history, requiring them to use medications that previously failed to address their medical issue, or could have dangerous side effects.

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, treatments are expected to be ineffective, treatments are contraindicated or will likely cause an adverse reaction or harm to the patient, the treatment has or will prevent the patient from fulfilling their responsibilities at work or performing daily living activities, or the patient is stable with their current treatment that was covered by their previous insurance plan.

“Introduction of the bi-partisan Senate Safe Step Act is a significant victory for the millions of Americans living with complex and chronic health conditions like psoriasis and psoriatic arthritis. This robust legislation has the potential to benefit over 150 million Americans by enabling patient access to treatments prescribed by their health care provider, regardless of whether or not the treatment is on their insurance providers preferred formulary,” said Randy Beranek, CEO, and president, NPF. “We commend Senators Murkowski, Jones, Cassidy, Hassan, Hyde-Smith, and Rosen for their commitment to provide patient protections and for understanding the critical need for federal legislation to keep patients and their health care providers as the primary decision-makers when it comes to selecting the best treatments for managing their health.”

The introduction of this act is an important milestone for patients everywhere especially for those managing chronic conditions like psoriasis and psoriatic arthritis. Congressional action on the Safe Step Act could mean that the 49 percent of Americans that utilize employer-sponsored health insurance would not be forced to try and fail insurance mandated treatment regimens before accessing the medication that is best suited to manage their disease and live a productive life.

Recognized as a trailblazer by our peers, NPF has demonstrated the expertise to successfully navigate federal and state legislatures, resulting in patient-friendly step therapy protections in 25 states, removing barriers for patients to access care, and increasing investment in critical psoriatic disease research. NPF assists in leading an informal federal step therapy working group of more than 40 patient and provider organizations. In collaboration with this group, NPF led efforts to identify Senate champions, lend institutional knowledge and patient stories to members of Congress and their staff, and coordinate efforts to grow stakeholder support for this legislation.

On behalf of the more than 8 million Americans living with psoriasis and psoriatic arthritis, the NPF continues to work to ensure that patients have access to affordable and effective treatments, reduce barriers to access adequate health care, and improve the lives of those living with psoriatic disease.