Washington, D.C. — June 30, 2025 — The not-for-profit Aimed Alliance, released a comprehensive new report analyzing how state policies govern step therapy, internal and external appeal oversight, and the use of artificial intelligence (AI) in health care coverage decisions.
Health plans rely on a variety of benefit utilization policies, such as step therapy, to limit access to certain medications. While these policies are intended to control costs, they can undermine clinical decision-making and require patients to continue to experience symptoms without relief. Without proper safeguards, step therapy can result in delays, inappropriate treatment, and irreversible disease progression. Recognizing the harm these practices can cause, more than half of U.S. states have enacted laws to limit the use of step therapy.
Yet, Aimed Alliance’s new report finds that consumers still face significant barriers due to inconsistent legislative implementation, limited oversight, and the increasing use of AI-driven decision tools.
“Step therapy policies, particularly when left unregulated, create perilous roadblocks between patients and the treatments they need,” said Ashira Vantrees, Director of Legal Strategy and Advocacy at Aimed Alliance. “This report identifies where protections exist, where gaps remain, and how states can better ensure timely access to clinically appropriate care.”
The report features:
• An analysis of laws and trends in regulating the use of step therapy by both commercial health insurance markets and Medicaid programs;
• An examination of state reporting requirements related to step therapy, internal appeals, and external appeals;
• A detailed analysis of proposed and enacted policies addressing the use of artificial intelligence in benefit utilization practices; and
• A comprehensive state-by-state breakdown of step therapy laws, oversight mechanisms, reporting requirements, and available appeals data.
This resource is intended to inform policymakers, enforcement agencies, advocates, and other stakeholders working to advance fair and evidence-based health insurance practices. By identifying policy trends, regulatory gaps, and enforcement challenges, Aimed Alliance seeks to advance sound policy and protect patients from harmful utilization management practices. Read the Report.
_____________________________________________________________________________________________________
About Aimed Alliance
Established in 2013 and based in Washington, D.C., Aimed Alliance is a non-profit health policy organization that works to protect and enhance the rights of healthcare consumers and providers. Aimed Alliance achieves this mission by conducting legal research and analysis; developing sound, patient-centered policy recommendations; and disseminating its findings to inform policymakers and increase public awareness. Learn more about Aimed Alliance at aimedalliance.org or on social media at @AimedAlliance.
Last Updated on June 30, 2025 by Aimed Alliance
