Over 100 Patient and Provider Organizations call on leadership to include ‘Safe Step Act’ in U.S. House and Senate PBM reform legislation

Millions of people with diagnosed arthritis and other chronic illnesses rely on their doctor to prescribe the most effective medications and treatments for their condition. When insurance providers require patients to first “try and fail” on lower-cost medications, the disruptions in treatment can lead to irreversible disease progression and worsen the patient’s medical condition. As the voice of the arthritis community we serve, the Arthritis Foundation strongly encourages Congress to center the needs of patients and pass comprehensive PBM reform legislation, and to include the Safe Step Act (S. 632/H.R. 2630) in the final package.

WASHINGTON, D.C. (November 8, 2023) -  With just weeks left in this Congressional session, patient advocates and health care professionals are calling on leaders in the United States Senate and House of Representatives to include language that addresses issues with step therapy—an insurance industry protocol that can delay patient access to medications —in Congress’ final Pharmacy Benefit Manager (PBM) reform legislation.

In a letter to Senate leaders Schumer (D-NY) and McConnell (R-KY) and House Speaker Johnson (R-LA) and Minority Leader Representative Jeffries (D-NY) the organizations representing disease states from arthritis to cancer to psoriasis emphasized that comprehensive PBM reform must include the guardrails that Safe Step Act (S. 652/H.R. 2630) provides:

“…it is of paramount importance to incorporate patient-centric changes that will directly enhance consumer access to critical treatments. The Safe Step Act – endorsed by over 215 patient and provider organizations – empowers patients to seek effective treatment if a step therapy protocol is not suitable for them. Furthermore, it streamlines step therapy exceptions requests for patients and their physicians, all while fortifying the vital patient-provider relationship.”

The Safe Step Act was amended and included in S. 1339, the Pharmacy Benefit Manager Reform Act in May 2023. 

Similar legislation has been passed and successfully implemented in 37 states. While the state laws are a step forward for many patients, millions of Americans in those states and across the nation do not have access to a timely step therapy exceptions process because self-insured employer health plans are exempt from state laws.

Neither the Safe Step Act nor the state laws prohibit step therapy, but rather put common sense parameters and reasonable timelines around the practice. The legislation will give patients and their doctors a transparent and standardized process to appeal step therapy requirements for patients needing a particular treatment without interference.

“So many employees and family members that I encounter have dealt with insurance-mandated step therapy. This disruption in care has led to weeks out of the office, and even required surgeries and permanent joint replacement. To truly support the patient community and bolster the patient-provider relationship, Congress must pass the Safe Step Act in their PBM reform package,” said Leah Howard, JD, President and CEO National Psoriasis Foundation.

We urge leaders in both chambers to include the Safe Step Act in the final PBM reform legislation.




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

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