ACR praises Representatives Ruiz and Wenstrup for introducing bipartisan step therapy legislation

Reviewed by James Ives, M.Psych. (Editor)Apr 12 2019

The American College of Rheumatology today praised Representative Raul Ruiz, MD (D-CA) and Representative Brad Wenstrup, MD (R-OH) for introducing the "Safe Step Act" (H.R. 2279). If enacted, H.R. 2279 would place reasonable parameters around the use of step therapy among employer-sponsored health plans.

"As physician leaders in Congress who have encountered step therapy in their own practices, Representatives Ruiz and Wenstrup understand the urgent need to streamline the step therapy process, which too often prevents or delays patients from receiving medically necessary therapies," said Paula Marchetta, MD, MBA, president of the American College of Rheumatology. "This common-sense, bipartisan legislation would place reasonable limits on the use of step therapy and create a clear process for patients and doctors to seek exceptions. We applaud Representatives Ruiz and Wenstrup for championing this important piece of legislation."

Step therapy - also known as "fail first" - is a utilization management technique employed by a majority of public and private health insurers that forces patients to try therapies preferred by the insurance company before being approved for the therapy their doctor prescribed - even when doctors doubt the "insurer preferred" option will be effective.

Step therapy undermines the clinical judgment of health care providers, leads to delays in effective therapy, and puts patients' health at unnecessary risk. A 2016 survey by the Arthritis Foundation found that most respondents experienced negative health effects from treatment delays caused by step therapy. According to the survey:

• More than 50% of all patients reported having to try two or more different drugs prior to getting the one their doctor had originally ordered;
• Step therapy was stopped in 39% of cases because the drugs were ineffective;
• Step therapy was stopped in 20% of cases due to worsening conditions; and
• Nearly 25% of patients who switched insurance providers were required to repeat step therapy with their new carrier.

"Step therapy is a prime example of payers interfering with patient care - what many have called practicing medicine without a license - and we are advocating to restore the power of the physician to treat their patients appropriately and in accordance with accepted guidelines," said Dr. Marchetta. "Our patients often try multiple drugs before finding one that works for them, so the ability to remain on a drug that works - without having to go through step therapy - is critical."