When you prescribe one medication for a patient , but their insurance company requires you try something else first – that’s step therapy or "fail first".

Many health insurers are using step therapy, which can undermine the prescriptions you want your patient to have. 

Why is step therapy reform needed? 

“For some patients, to fail on a medication could mean serious health setbacks,” said Shannon Trotter, DO, a Board-Certified Dermatologist in Springfield. “For example, someone with epilepsy could have a seizure; someone with mental illness could have a psychotic episode; someone with psoriasis could endure a prolonged skin rash outbreak; for someone with arthritis, the pain and swelling of joints could persist to the point of needing surgery; or for someone with cancer, the chance of reaching remission or being cured, could be delayed while the cancer worsens."

Help us reform step therapy now!

“Ohioans for Step Therapy Reform” is a coalition of more than 50 patient and physician organizations that are working together to advocate for legislation to reform step therapy procedures in Ohio.  Join us in taking steps to reform step therapy in Ohio by contacting your state legislators through this website.

 Download an Ohio  Step Therapy Fact Sheet for more information. 

Latest News

Ohio Congressman Introduces Step Therapy Reform Bill

WASHINGTON, D.C. – Congressman Brad Wenstrup (R-OH) and Congressman Raul Ruiz (D-CA) introduced The Restoring the Patient’s Voice Act. This legislation is designed to give providers increased autonomy in determining the care that is best for their patients.

Study Confirms Administrative Burdens Related to Fail First Policies

A national study found that during a typical day, primary care physicians spend 49 percent of their time dealing with administrative red tape. The authors of this study concluded that for every hour primary care physicians spend in direct patient care, they spend two hours engaged in administrative functions.

Letter To Editor Stresses Need for Step Therapy Reform

Read why one pediatric pulmanologist, Benjamin Kopp, MD, tells Columbus Dispatch readers that Ohio needs step therapy reform: http://www.dispatch.com/opinion/20170430/letter-reform-use-of-step-therapy

Step Therapy Reform Proponents Testify in Ohio Senate

Proponents of SB 56, told members of the Senate, Health, Human Services and Medicaid Committee, March 7, that step therapy can be a useful tool for controlling costs, but exemptions are necessary to protect patient safety and timely access to effective treatments.

Ohio legislation would reform ‘Step-therapy’ insurance

COLUMBUS (WCMH) — Representatives of the medical community, patient advocates and provider groups gathered with lawmakers, Feb. 9, at the Statehouse to kickoff an effort to reform an insurance industry practice known as “step therapy.”

State Senators Peggy Lehner (R-Kettering) and Charleta Tavares (D-Columbus) have introduced Senate Bill 56, which seeks to address a health insurance industry practice known as “fail first” or “step therapy.”   

Rep. Terry Johnson (R-McDermott) and Rep. Nickie Antonio (D-Lakewood) also introduced a companion bill in the Ohio House, HB 72. To date, eleven other states have passed laws to reform step therapy practices. 

Urge Ohio lawmakers to support Senate Bill 56 and House Bill 72!

Senate Bill 56 and House Bill 72 would not ban step therapy, or the number of steps an insurer can implement. The bills require that an insurer’s process for requesting a step therapy override is transparent and available to the provider and patient.  Other provisions include:

  • Allowing automatic exceptions to step therapy requirements when:
    • The required prescription drug is contraindicated or will likely cause an adverse reaction
    • The required prescription drug is expected to be ineffective
    • The patient has previously tried the required drug or a drug in the same pharmacologic class and the drug was ineffective or caused an adverse event
    • The  required prescription drug is not in the best interests of the patient based on medical appropriateness
    • The patient is stable on a prescription drug for the medical condition under consideration
    • The patient has changed insurance coverage and the patient has already gone through step therapy with the previous insurer
  • Ensuring that step therapy programs are based on clinical guidelines developed by independent experts.

Ohioans For Step Therapy Reform 

Academy of Medicine of Cleveland and Northeast Ohio • Advocacy Council of the American College of Allergy, Asthma and Immunology • American Academy of Dermatology Association • American Academy of Pediatrics Ohio Chapter • American Association of Diabetes Educators • American Cancer Society Cancer Action Network • American College of Rheumatology • American College of Surgeons, Ohio Chapter • American Diabetes Association • American Lung Association, Ohio and Michigan • Arthritis Foundation, Ohio • Cancer Support Community, Greater Cincinnati-Northern KY and Central Ohio • Central Ohio Diabetes Association • Chi Eta Phi Sorority, Inc. • Cincinnati Area Senior Services • Coalition of State Rheumatology Organizations • Columbus Chapter Black Nurses Association • Crohn's & Colitis Foundation of America: national, Central Ohio, and Southwest Ohio • Diabetes Partnership of Cleveland • Leukemia & Lymphoma Society • Lupus Foundation of America, Greater Ohio • Mended Hearts of Central Ohio • Mended Hearts, National • Mental Health & Addiction Advocacy Coalition • Mental Health America of Franklin County • Myasthenia Gravis Foundation of America, Columbus Support Group • National Alliance on Mental Illness, Ohio • National Kidney Foundation, Central Ohio • National Liver Foundation, Heartland Division • National Multiple Sclerosis Society • National Organization for Rare Diseases • National Patient Advocate Foundation • National Psoriasis Foundation • Ohio Academy of Family Physicians • Ohio Asian American Health Coalition • Ohio Association of Advanced Practice Nurses • Ohio Association of County Behavioral Health Authorities • Ohio Association of Rheumatology • Ohio Bleeding Disorders Council • Ohio Dermatological Association • Ohio Federation for Health Equity and Social Justice • Ohio Foot and Ankle Medical Association • Ohio Hematology Oncology Society • Ohio Nurses Association • Ohio Osteopathic Association • Ohio Pharmacist Association • Ohio Psychiatric Physicians Association • Ohio Sickle Cell and Health Association • Ohio State Medical Association • Prescription Assistance Network of Stark County, Inc. • Prevent Blindness Ohio • Public Children Services Association of Ohio • Susan G. Komen Columbus • Susan G. Komen Northeast Ohio • Susan G. Komen Northwest Ohio • Susan G. Komen Southwest Ohio • The Epilepsy Association (serving northeast Ohio) • The Ohio Council of Behavioral Health & Family Services Providers • U.S. Pain Foundation

 

Step therapy is being used to deny necessary medications to patients with many health conditions, ranging from mental illness to diabetes to arthritis and even cancer. Please help change this damaging practice by speaking out about how step therapy has affected your patients and your office.

The most powerful way to reform step therapy is to let legislators know how step therapy adversely affects your patients. How has step therapy interfered with medication management? How has it delayed effective treatment?  Has the delay interfered with effective patient care?  How long does it take office staff to appeal a decision and what hassles are involved?

Tell Us Your Story

After sharing your story here, we may be in touch with you via your email address to get further details and determine the best way to share your story with legislators. All shared stories are subject to review and approval.

Send a message to the legislature