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Dr. Wenstrup, Dr. Ruiz Introduce Safe Step Act to Require Insurance Companies to Put Patients’ Health First

Washington, April 18, 2019 Contact: Ann Tumolo (202-225-3164)
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Washington, D.C. – Today, Representative Brad Wenstrup, D.P.M. (R-OH) and Representative Raul Ruiz, M.D. (D-CA) announced the introduction of H.R. 2279, the Safe Step Act, a bipartisan bill to improve step therapy protocols and ensure patients are able to safely and efficiently access the best treatment for them. Sometimes, step therapy protocols can cause unnecessary delays in care, or worse, require patients to try ineffective or potentially dangerous medications before finding the treatment most suited to their needs.

“For too many, step therapy is known as ‘fail first’ because it forces patients to try and fail treatments before getting what their doctor originally prescribed,” said Dr. Brad Wenstrup. “This can lead to dangerous delays in treatment and additional costs for the patient and our health care system. The Safe Step Act would create common sense protections for patients to ensure that patients get what is best for them and doctors can assure that they ‘do no harm.’”

“As a physician, I took an oath to put patients first. The Safe Step does exactly that,” said Dr. Ruiz. “It is not safe or fair for patients to be forced to use medications that don’t work for them because of insurance companies’ rigid, profit-motivated protocols. These delays can cause unnecessary pain and suffering for patients. My bipartisan bill will help patients get the medicine they need to live healthy, productive lives. I was pleased to work across the aisle with a fellow doctor, Congressman Wenstrup, to develop a patient-centered approach to step therapy protocols that puts the health of Americans first.”

 

Background

Currently, when a physician prescribes a particular drug treatment for a patient, the patient’s insurance company may require them to try different medications and treatments before they can access the drug originally prescribed by their physician. This protocol is known as “step therapy” or “fail first.”

Unfortunately, step therapy protocols often ignore a patient’s unique circumstances and medical history. That means patients may have to use medications that previously failed to address their medical issue, or – due to their unique medical conditions – could have dangerous side effects.

To address this issue, Dr. Wenstrup introduced H.R. 2279, the Safe Step Act, with Rep. Raul Ruiz, a fellow doctor. The bill would require insurance companies to implement a clear process by which the patient or provider can request an exception, which must be readily available on the website of the health plan. It would also require approval from the insurance company within three days; or 24 hours if the patient’s life is in danger. The exceptions specified in the bill include:

  • The required drug is contraindicated.
  • The required treatment is reasonably expected to be ineffective due to the known characteristics of the patient and the known characteristics of the treatment (i.e. ingestion method).
  • The required treatment is likely to cause an adverse reaction or other physical harm to the patient.
  • The required treatment is not in the best interest of the patient, based on medical necessity, because the patient’s use of such treatment is expected to decrease his/her ability to perform on the job.
  • The patient is already stable on the prescription drug selected by his or her provider.

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