Safe Step Act
Congress Proposes New Rules to Help Patients Skip Insurance 'Fail-First' Drug Requirements
Legislative Progress
Key Points
- This bill targets 'step therapy,' a practice where insurance companies make patients try cheaper drugs that might not work before they will pay for the medicine a doctor originally prescribed.
- Health plans would be required to create a clear and fast way for patients or doctors to ask for an exception if the insurance company's preferred drug is dangerous, ineffective, or would cause the patient's condition to get worse.
- Insurance companies would have to make a decision quickly: within 72 hours for regular requests and within 24 hours if a patient’s life or health is in immediate danger.
- Exceptions must be granted if a patient is already stable on their current medicine or if the insurance company's required drug would prevent them from working or taking care of themselves.
- If an exception is approved, the insurance company must continue to cover that specific drug for at least one year to ensure the patient's treatment is not interrupted.
Impact Analysis
Personal Impact
Life & Work
Small businesses that offer group health plans would need to ensure their plans comply with the new step therapy exception requirements. This could mean minor administrative adjustments and potentially slightly higher plan costs if more exceptions are granted. However, healthier employees who get the right medication faster could also reduce absenteeism and improve productivity.
Programs
Disabilities
Milestones
Committee on Health, Education, Labor, and Pensions. Hearings held.
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
Sent to a congressional committee for expert review. The committee decides whether this bill moves forward.
Introduced in Senate
The bill was officially filed and given a number. It now enters the legislative queue.
Votes
No votes have been recorded for this legislation yet.
Related News
3 articlesLegislative Report: 119th Congress - Safe Step Act
The Safe Step Act (S. 2903 / H.R. 5509) requires group health plans to establish a clear, prompt, and transparent process for patients or prescribers to request exceptions to medication step therapy protocols, with specific circumstances for approval and strict timelines for responses.
Congress reintroduces Safe Step Act to amend step therapy policies
In September, members of the U.S. House and Senate reintroduced the Safe Step Act, which will require group health insurance plans to offer a timely exceptions process when step therapy is not in a patient's best interest. The bill aims to reduce treatment delays and physician burnout.
MGMA backs Safe Step Act to curb step therapy
The Medical Group Management Association (MGMA) has signaled its support for the Safe Step Act, emphasizing that the legislation would reduce administrative burdens and ensure patients receive prescribed medications without unnecessary insurance-mandated delays.
Source Information
Document Type
Congressional Bill
Official Title
Safe Step Act
Data Sources
Sponsor
Cosponsors
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