Safe Step Act

Safe Step Act

This bill requires a group health plan to establish an exception to medication step-therapy protocol in specified cases. A medication step-therapy protocol establishes a specific sequence in which prescription drugs are covered by a group health plan or a health insurance issuer. 

A request for such an exception to the protocol must be granted if (1) an otherwise required treatment has been ineffective, (2) such treatment is expected to be ineffective and delaying effective treatment would lead to irreversible consequences, (3) such treatment will cause or is likely to cause an adverse reaction to the individual, (4) such treatment is expected to prevent the individual from performing daily activities or occupational responsibilities, (5) the individual is stable based on the prescription drugs already selected, or (6) there are other circumstances as determined by the Employee Benefits Security Administration.

The bill requires a group health plan to implement and make readily available a clear process for an individual to request an exception to the protocol, including required information and criteria for granting an exception. The bill further specifies timelines under which plans must respond to such requests.

The Safe Step Act, also known as Bill 118 hr 2630, is a piece of legislation currently being considered by the US Congress. The purpose of this bill is to address the issue of step therapy, which is a practice used by insurance companies to require patients to try and fail on lower-cost medications before they can receive coverage for the medication prescribed by their healthcare provider.

The Safe Step Act aims to protect patients by establishing guidelines for step therapy protocols. It requires insurance companies to implement a clear and transparent process for requesting exceptions to step therapy requirements. This process must be based on clinical guidelines and take into account the individual needs of the patient.

Additionally, the bill requires insurance companies to respond to these exception requests in a timely manner, ensuring that patients are not left waiting for necessary medications. It also allows for expedited review in cases where a delay in treatment could cause harm to the patient. Overall, the Safe Step Act seeks to prioritize the health and well-being of patients by ensuring that they have timely access to the medications prescribed by their healthcare providers. This legislation has garnered bipartisan support and is seen as a positive step towards improving patient care in the United States.