Medication step therapy protocols would be improved under bipartisan legislation sponsored last week by U.S. Rep. Brad Wenstrup (R-OH).
Step therapy is a program that requires patients to try a lower cost prescription drug that treats a given condition before “stepping up” to a similar-acting, but more expensive drug, according to Healthinsurance.org, which says step therapy is also known as either “step protocol” or “fail first requirements.”
“Under the current system, many insurers are requiring patients to ‘fail first’ on other medications before they can receive the medication their physician originally prescribed,” Rep. Wenstrup said. “Spending precious time and money on multiple alternative treatments can be very dangerous for patients and leads to delays in treatment and additional costs for our health care system.”
The congressman introduced the Safe Step Act, H.R. 2630, with five original cosponsors, including U.S. Reps. Mariannette Miller-Meeks (R-IA) and Raul Ruiz (D-CA) to require insurance companies to have a clear and rapid process that would allow coverage for the medication or treatment that is best for the patient, according to a bill summary provided by the lawmakers.
“This bipartisan bill creates guardrails to ensure patients receive common-sense protections and doctors can assure that they do no harm,” said Rep. Wenstrup.
Specifically, H.R. 2630 would amend the Employee Retirement Income Security Act of 1974 to require a group health plan or health insurance coverage offered in connection with such a plan to provide an exceptions process for any medication step therapy protocol, according to the text of the bill.
“It is not safe or fair for patients to be forced to use medications that don’t work for them simply because of insurance companies’ protocols that do not take the patient’s unique health needs into account,” said Rep. Ruiz. “These delays can cause unnecessary pain, suffering, and cost for patients. My bill will help patients get the medicine they need to live healthy, productive lives.”
H.R. 2630 is the companion bill to the same-named S. 652, introduced on March 2 by bill sponsor U.S. Sen. Lisa Murkowski (R-AK) and 18 original cosponsors, including U.S. Sens. Thom Tillis (R-NC), Shelley Moore Capito (R-WV), Susan Collins (R-ME), Roger Wicker (R-MS), and Maggie Hassan (D-NH).