The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) has endorsed bipartisan legislation pending in the U.S. Senate and House of Representatives that has the potential to improve patient access to care and reduce payer interference in physician-patient medical decisionmaking. 

Oftentimes, when a physician prescribes a particular drug or biologic for a patient, the patient’s insurance company may require them to first try a different therapy. 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 a patient may have to use a medication that previously failed to address their medical issue or that could have dangerous side effects due to a patient's unique medical condition.

Common-sense guardrails to step therapy are needed to ensure patients can safely and efficiently access the best and most effective treatment available.

Ask lawmakers to cosponsor the Safe Step Act (S. 2903 / H.R. 5509).

The Safe Step Act amends the Employee Retirement Income Security Act (ERISA) to require a group health plan to provide an exception process for any medication step therapy protocol. 

The bill:

- Requires insurers to implement a clear and transparent process for a patient or physician to request an exception to a step therapy protocol. 

- Requires that a group health plan grant an exemption if an application clearly demonstrates any of the following five situations:

1. The patient has already tried and failed the required drug.
2. The drug is reasonably expected to be ineffective, and a delay of effective treatment would have severe or irreversible consequences.
3. The treatment is contraindicated or has caused/is likely to cause an adverse reaction.
4. The required drug will prevent a patient from working or fulfilling Activities of Daily Living.
5. The patient is already stable on the prescription drug selected by his or her provider, and that drug has been covered by their previous or current insurance plan.

- Requires a group health plan to respond to an exemption request within 72 hours in all circumstances, and 24 hours if the patient’s life is at risk.

Congress must be compelled to pass the Safe Step Act in the 119th Congress, and that requires a strong show of support by lawmakers through their cosponsorship of the legislation. The more cosponsors a bill has, the more likely it is to receive a vote and this is why NASPGHAN is asking for your help.

Members of Congress need to hear from you, their constituents, about why the Safe Step Act is important to you and your patients.

Take a moment today to email your members of Congress and ask for their cosponsorship of this legislation.