Drug access and affordability

Step therapy is a tool used by health plans to control spending on patient medications. Typically, it requires a doctor to prescribe a cheaper alternative to the medication or treatment the doctor believes will provide best care for the patient.

The Academy opposes step therapy and “fail first” strategies because they impede treatment and have been shown to have a negative impact on patients.

Step therapy blocks patient access to medications, interferes with the physician’s decision-making, and undermines the doctor-patient relationship.

The Academy supports the “Safe Step Act,” which is proposed federal legislation intended to protect patients from undue step therapy burdens and ensure physicians remain the clinical authority over care. The bill is modeled after state legislation drafted by a coalition that includes the Academy, the State Access to Innovative Medicines Coalition (SAIM).

The Academy has also supported step therapy laws at the state level. To date, nearly two-thirds of the states have enacted step therapy reform laws that include many provisions of the SAIM model bill. The Academy will continue to work with state legislatures until step therapy has been reformed throughout the United States.

View a map of states that have enacted step therapy laws based on the SAIM model bill.

Nonmedical switching

The Academy also advocates for legislation that prohibits insurers from forcing a patient to switch from a covered prescription drug to another medication in the middle of the policy year. Normally, this is a result of an insurer’s decision to remove or reclassify a covered prescription drug from its list of covered drugs. To avoid the adverse effects of switching therapies and to support adherence to a prescribed treatment plan, health plans should honor the formularies for the full plan year.