The American Society for Gastrointestinal Endoscopy (ASGE) has once again endorsed legislation pending in Congress that has the potential to improve patient access to care and reduce payer interference in physician-patient medical decision-making..
The Safe Step Act (S. 2903 / H.R. 5509) creates a clear, timely and transparent process for a patient or physician to request an exception to step therapy protocols in certain situations.
The Safe Step Act amends the Employee Retirement Income Security Act (ERISA) to require a group health plan provide an exception process for any medication step therapy protocol.
The bill:
- Requires insurers 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:
- The patient already tried and failed on the required drug.
- The drug is reasonably expected to be ineffective, and a delay of effective treatment would lead to severe or irreversible consequences.
- The treatment is contraindicated or has caused/is likely to cause an adverse reaction.
- The required drug will prevent a patient from working or fulfilling Activities of Daily Living.
- 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 respond to an exemption request within 72 hours in all circumstances, and 24 hours if the patient’s life is at risk.
The bill also requires that a request for an exception to step therapy be answered by the insurance company within three days, and in less than 24 hours if the patient’s life is at risk.
Lawmakers need to hear from you, their constituents, about why passage of the Safe Step Act is important to you and your patients.
Take a moment today to send an email to your members of Congress asking for their cosponsorship of the Safe Step Act.
Taking action only takes a couple minutes though the ASGE Action Center.