What is step therapy/fail first?
Have you been required by your health insurer to try and fail on a medication before they will provide coverage for your original provider-prescribed treatment? If so, you've been subjected to step therapy, also known as "fail first". Recent surveys indicate that over 40 percent of patients with Crohn's disease and ulcerative colitis have had to try and fail on one or more drug(s) before accessing the provider-prescribed treatment. Dealing with fail first protocols while living with inflammatory bowel diseases (IBD) can be physically and emotionally draining.
Learn more about step therapy
Check out the Crohn's & Colitis Foundation's resources to learn more about step therapy and what you can do if you have been affected:
What has your state done to address step therapy?
Click on our interactive map below to see what your state has done to address step therapy protocols and how you can join the Foundation's advocacy efforts to pass legislative reform:
- Patient protections enacted
What is a target state?
In conjunction with partners across the country, the Crohn's & Colitis Foundation is advocating for step therapy reform in strategically selected 'target' states. The Foundation is actively educating the legislatures in each respective state on how step therapy/fail first negatively affects IBD patients and how they could benefit from step therapy reform.
What are we working towards?
The Foundation, as part of a coalition of patient and provider groups, worked to craft model legislation designed to provide relief for all people with chronic diseases who are affected by step therapy protocols. While not a full ban on the use of step therapy, the model legislation accomplishes the following:
- Creates a balance between ensuring the health of the patient and containing overall health care costs
- Provides for a timeline of response for step therapy exception requests (within 24 hours for emergencies or 72 hours for non-emergencies)
- Outlines clear exceptions to fail first protocols that are based on medical necessity
- Ensures that step therapy protocols and the process to appeal them are transparent to patients and their providers and is based on the most current clinical data
What are we doing in Congress?
In order to ensure all chronic disease patients have protections from step therapy/fail first protocols, the Foundation is also working towards passing similar legislation in Congress. Known as the Safe Step Act (H.R. 2279/S. 2546), these efforts also seek to ensure a clear and more convenient step therapy appeal process, establish a timeline for response from insurers, and ensures that the protocols are based on sound clinical data. The Safe Step Act is sponsored by Representatives Brad Wenstrup and Raul Ruiz in the House and Senators Bill Cassidy, Doug Jones, and Lisa Murkowski in the Senate.