Advocacy in Missouri 

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State Fact Sheet 
Find out how arthritis affects people in Missouri and what you can do to make a difference. 

State of Your Health 
If you are experiencing a barrier to care, you should contact your insurance commissioner, who can help address your situation. Please be sure to view our Missouri Department of Insurance fact sheet that gives instructions on how to appeal, request an external review or file a complaint with your insurance commissioner.

What is step therapy?   

Step therapy is a practice used by insurers that requires people with arthritis to try lower-cost medications before permitting more expensive treatments, even when the doctor wants to prescribe them. In other words, more expensive and effective drugs can only be prescribed if the cheaper ones prove ineffective.  

How does this new law address step therapy in  Missouri?  

In 2016, Missouri passed legislation to address step therapy and the law went into effect in early 2018.  This new law increases the ability of the patient’s health care provider, not insurance company, to make important decisions about a patient’s treatment.  More specifically this law requires state regulated health plans to provide physicians and patients with access to a clear and timely process for requesting an exception to a step therapy protocol.  A health plan must also grant an immediate override of the step therapy protocol if the patient has already tried the “fail first” prescription drug under current or previous health plan.  

Which patients will benefit from this new law?  

Patients who have state regulated health plans.  Self-insured health plans, where benefits are paid directly from employer and the health plan acts as just a claims administrator, are subject to ERISA and generally are not subject to state insurance laws.  To learn if you are covered, contact your insurer and provide your policy number.    

What should I do if I experience this barrier to care in  Missouri?  

If you are experiencing a barrier to care, you should contact your insurance commissioner, who can help address your situation. You can easily find instructions on how to appeal, request an external review, or file a complaint to your Insurance Commissioner with our Department of Insurance one pager, click here to learn more. 

• Learn more about how the law affects Missourians by watching this short video
• View or download the video slides
• View and print our easy to use handout explaining the impact of the new law 

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