The Tourette Association of America supports S.464/H.R. 2163, the Safe Step Act, which would require group health plans to provide an exception process for any medication step therapy protocol.
What is step therapy?
It is a utilization management tool used by health plans to control spending on patient’s 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.
What would the Safe Step Act do to improve my ability to receive my prescriptions?
First, it would establish a clear exemption process and require group health plans to respond to an exemption request within 72 hours in all circumstances, and 24 hours if the patient’s life is at risk. Additionally it creates 5 exceptions (exemptions required to be granted) to fail first protocols:
- Patient already tried and failed on the required drug
- Delayed treatment will cause irreversible consequences
- Required drug will cause harm to the patient
- Required drug will prevent a patient from working or fulfilling Activities of Daily Living (basic personal everyday activities such as eating, toileting, grooming, dressing, bathing, and transferring (42 CFR § 441.505).
- Patient is stable on their current medication.
The TAA’s Take Action letter asks Senators & Representatives to support the Safe Step Act, and TAA’s other policy priorities. If you have not already done so, please take a moment to complete the Take Action letter to ask for support for this important piece of legislation!