Sponsors

FL
Lois Frankel
Lois Frankel
LA
Garret Graves
Garret Graves
WA
Jaime Herrera Beutler
Jaime Herrera Beutler
TX
Ronny Jackson
NJ
Andy Kim
Andy Kim
NJ
Tom Malinowski
Tom Malinowski
DC
Eleanor Holmes Norton
Eleanor Holmes Norton
FL
Bill Posey
Bill Posey
MD
Jamie Raskin
Jamie Raskin
OH
Michael R. Turner
Michael R. Turner
PA
Susan Wild
Susan Wild
MA
Jake Auchincloss

House

Senate

President

REFERRED TO COMMITTEES

hr-2163

To amend the Employee Retirement Income Security Act of 1974 to require a group health plan or health insurance coverage offered in connection with such a plan to provide an exceptions process for any medication step therapy protocol, and for other purposes.

Safe Step Act

This bill requires a group health plan to establish an exception to medication step-therapy protocol in specified cases. A medication step-therapy protocol establishes a specific sequence in which prescription drugs are covered by a group health plan or a health insurance issuer. 

A request for such an exception to the protocol must be granted if (1) an otherwise required treatment has been ineffective, (2) such treatment is expected to be ineffective and delaying effective treatment would lead to irreversible consequences, (3) such treatment will cause or is likely to cause an adverse reaction to the individual, (4) such treatment is expected to prevent the individual from performing daily activities or occupational responsibilities, (5) the individual is stable based on the prescription drugs already selected, or (6) there are other circumstances as determined by the Employee Benefits Security Administration.

The bill requires a group health plan to implement and make readily available a clear process for an individual to request an exception to the protocol, including required information and criteria for granting an exception. The bill further specifies timelines under which plans must respond to such requests.