Step therapy policies, also referred to as “fail first,” require insured individuals to try and fail on alternative treatments, sometimes with adverse effects, before the insurer or pharmacy benefit manager will cover the prescribed treatment. Step therapy policies can be unethical and inconsistent with sound scientific and clinical evidence, resulting in interference with the practitioner-patient relationship and significant delays in access to prescribed treatments.
States have introduced legislation to address step therapy. Please click on the map below for state-specific information on legislation introduced this session.
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