Support for Step Therapy Protections Gains Traction in Congress, Academy to Support Senate Legislation

A new, bipartisan proposal in the U.S. Senate is offering much-needed protections for private patients for whom step therapy might otherwise interfere with their existing treatment. 

The Safe Step Act of 2019 would amend the Employee Retirement Income Security Act to require group health plans to establish an exception process for “any medication step therapy protocol.” It would also insert more transparency into the process to aid patients’ exception requests. 

This legislation would not affect Medicare patients. However, it would provide private patients with some of the very basic protections that have been instituted for Medicare Advantage beneficiaries. 

For example, group plans would have to grant an exception if a patient has already tried and failed on the required drug. The Safe Step Act would also require that a group health plan grant an exemption if an application clearly demonstrates any of the following situations: 

• Delayed treatment will cause irreversible consequences.
• Required drug will harm the patient.
• Required drug will prevent a patient from working or fulfilling activities of daily living.
• Patient is stable on current medication. 

The Academy has urged the Centers for Medicare & Medicaid Services to adopt further patient protections for its Medicare Advantage beneficiaries. 

It’s the first time in several sessions of Congress that lawmakers in the Senate have taken a position on this issue. The bill has strong bipartisan support. Its sponsors, Sens. Lisa Murkowski, R-Alaska, Doug Jones, D-Ala., and Bill Cassidy, MD, R-La., have enlisted three Democrats, three Republicans and one independent as co-sponsors. 

The Academy will send letters supporting the Safe Step Act, which is a companion to similar legislation already introduced by Reps. Raul Ruiz, MD, D-Calif., and Brad Wenstrup, R-Ohio, in the House of Representatives. The House bill has also received strong bipartisan support and currently has 99 cosponsors.