By Jacob R. Karr, MD
“Insanity is doing the same thing over and over again and expecting different results.”
This quote is often attributed to Albert Einstein, but the origins are not as important as the meaning. H.R. 2279 Safe Step Act was introduced on April 10, 2019 by Rep. Raul Ruiz (D-CA), a physician, and attempts to limit one of the frustrations physicians often encounter. Step therapy was introduced as a cost saving measure by insurance companies but, like many measures, quickly became a headache for practices and most importantly, patients. Step therapy, or sometimes called fail first, is an algorithm of pharmaceutical treatment designed by insurers that must be followed by providers and patients. The problem is the algorithm is not based on most effective therapy but rather most cost efficient for the insurer.
Imagine getting your dream job. You are ecstatic your career is finally moving in the direction you’ve always imagined. You go through the HR process, sign up for health insurance, 401(k), vision, dental, etc... After settling into your new job, you receive a letter of denial for the medication that has kept your chronic illness in check. You call your doctor’s office and the new insurer requires you go through a fail first protocol. You feel helpless. You know the medications they are requiring will not work. You’ve been down that road. You and your doctor have no choice. You must go through this process.
This situation is unfortunate but a reality. H.R. 2279 addresses this problem by creating a transparent, easy to access, standardized process to appeal these types of decisions made by the insurer. The Safe Step Act has rare bipartisan support, but no bill of this importance should be taken for granted. Please contact your representatives today.
Below are links to find your representative contact information.