Importance of Step Therapy Reform

Step therapy, also known as “fail first,” is a tool used by insurers that requires patients to try a less expensive treatment, or series of treatments, before they can access the drug originally prescribed by their physician. Overly burdensome step therapy requirements can jeopardize the patient-provider relationship and unnecessarily prolong ineffective treatment, preventing patients from immediately starting, or in some cases continuing, to access the most appropriate treatment recommended by their doctor.

Hunter Pruett, a Junior Ambassador from Atlanta, is one of many who have experienced a delay in care due to step therapy. At only 4 and a half years old, Hunter was diagnosed with juvenile idiopathic arthritis, experiencing painful, swollen joints, fever and fatigue.

Hunter’s physician prescribed a biologic medication to ease the pain and joint destruction. But his family’s insurance plan denied coverage, insisting that Hunter had to go through step therapy and “fail first” on another drug before they would consider approving the much-needed biologic.

After months of trying and failing the insurance plan’s preferred medication, Hunter eventually reached the plan’s step therapy length requirement, and the insurer agreed to provide coverage for the biologic the rheumatologist originally prescribed.

But the 14-month wait to get on the appropriate medicine left Hunter in immense pain, causing him to miss months of school and leaving him with permanent joint damage.

Hunter even needed surgery on both his knees to rehabilitate his joints so he could walk again. Legislation like the Restoring the Patient’s Voice Act would make much-needed reforms to step therapy requirements like what Hunter experienced. This law would give doctors like Hunter’s the power to use their best medical judgment to swiftly override the insurance company’s fail first requirement and make sure patients like Hunter can get the right treatment at the right time.

We need your help to make sure stories like Hunter’s don’t end with months of pain and joint damage. You can be a part of the solution. Join us in calling on Congress to introduce this important step therapy reform legislation in both the House and the Senate.

Last Congress, the first federal bill to reform step therapy requirements was introduced in the U.S. House of Representatives and it had a tremendous amount of support, with 88 representatives signing on as sponsors. It’s time to re-introduce this important legislation to our newly-elected 116th Congress, and we need your help to raise awareness and support.

In March, our 2019 Advocacy Summit participants will be taking their step therapy stories directly to members of Congress in Washington, DC, to advocate for this important legislation. We can do our part to amplify their message by sharing our support with our legislators.

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