Step therapy requires patients to try several medications and fail them before the initial therapy prescribed by a provider will be covered by a payer, according to the AGA.
Here’s what you should know:
1. Reps. Brad Wenstrup, R-Ohio, and Raul Ruiz, D-Calif., introduced the legislation.
2. The AGA supports it because the organization believes it “provides patients with a clear, equitable and fair appeals process when subjected to step therapy protocols.”
3. The AGA believes step therapy jeopardizes the physician-patient relationship because it bypasses what physicians believe will be the best treatment.
4. The legislation would require all employer-sponsored health plans to establish an appeals process for step therapy protocol, grant patients exceptions to step therapy under critical circumstances and expedite response times for all appeals.
5. AGA is collaborating with the Crohn’s and Colitis Foundation and several other professional societies to lobby legislators.
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