Congress is currently considering legislation to reform Pharmacy Benefit Managers (PBMs), with multiple bills being passed out of House and Senate Committees. The Safe Step Act, one of our top legislative priorities, was included in the Senate Health, Education, Labor, and Pensions (HELP) Committee’s PBM package.  

Step therapy, also known as ‘fail first,’ is utilized by insurers to determine drug coverage and requires patients to try and fail on insurers’ preferred medications before covering the initial therapy prescribed by their health care provider. This practice jeopardizes the physician-patient relationship, since it bypasses what the physician believes is the best treatment for their patient.  

The Safe Step Act (S. 464/H.R. 2163) would provide a clear and timely appeals process when a patient has been subjected to step therapy. It would require employer-sponsored health plans to:  

• Establish a clear and convenient process for physicians to appeal a step therapy protocol for their patient.  

• Grant patient exceptions to step therapy under five critical circumstances.  

• Expedite care by requiring a timely decision for appeals — three days or 72 hours or within 24 hours, if life-threatening. 

Congress will need to reconcile multiple PBM reform bills into a single legislative package. We need your help in urging Congress to include the Safe Step Act in the final PBM reform package.  

Personalized messages are especially effective. Please consider adding your own personal note in the letter to your member of Congress.