Arthritis Foundation Applauds Senate Committee Amendment to PBM Reform Legislation
The amendment puts common sense parameters around insurance industry’s step therapy programs.
If enacted, the bill would ensure that employer health plans offer a medically responsible and expedient step therapy expectations process.
Step therapy occurs when a patient’s insurer or PBM refuses to cover the cost of a medication until the patient tries and fails on treatments of their choosing. Without reform, step therapy-related delays in care can lead to severe or even irreversible health outcomes.
“We applaud the Senate HELP Committee for protecting millions of people with arthritis and other chronic conditions with this vote,” said Steve Taylor, president and CEO of the Arthritis Foundation. “The ability to get a medical exception to their insurance provider’s step therapy protocol is an example of the access to quality care these patients — and every patient — deserve.”
The Safe Step Act language does not ban the use of step therapy, but instead puts common sense parameters and reasonable timelines around the practice. The legislation will give patients and their doctors a transparent and standardized process to seek an exception to ineffective step therapy requirements, possibly causing harm or otherwise delaying necessary care.
“Step therapy directly impedes physicians’ability to deliver timely and targeted care,” said Clifford A. Hadis, MD, the Association for Clinical Oncology's chief executive officer. “The Safe Step Act puts guardrails in place to help patients access potentially lifesaving and life-extending medications in a timelier manner.”
“We are thrilled that members of the Senate HELP Committee see the importance of protecting patients and ensuring that patients can seek an exception to a step therapy protocol if it’s medically inappropriate,” added Leah Howard, JD, president and CEO of the National Psoriasis Foundation.
The Safe Step Act is supported by more than 200 patient and provider organizations. The HELP Committee amendment was put forth by Sen. Lisa Murkowski (R-AK) with support from Sens. Maggie Hassan (D-NH) and Doc Marshall (R-KS). The Pharmacy Benefit Manager Reform Act now goes to the full Senate for a vote.
About the Arthritis Foundation
The Arthritis Foundation is fighting for all people who live with arthritis. As Champions of Yes, the Arthritis Foundation’s mission is to turn the obstacles arthritis causes into opportunities. The Arthritis Foundation champions life-changing solutions and medical advancements, and it also provides ways for people to connect, break down barriers in health care and join the fight to conquer arthritis — uniting hearts, minds and resources to change the future of arthritis. To join the fight to conquer arthritis, visit arthritis.org.
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