Bill > S2903

This bill introduces the "Safe Step Act," which amends the Employee Retirement Income Security Act to require group health plans and health insurance issuers to establish a clear and transparent exceptions process for medication step therapy protocols (a practice where patients must try less expensive medications before insurance will cover a prescribed medication). The bill mandates that health plans create a process allowing patients or their healthcare providers to request an exception to step therapy under specific circumstances, such as when previous treatments have been ineffective, when delaying treatment could cause severe consequences, when a treatment is contraindicated, or when a patient is already stable on a current medication. The exceptions process must include a standard form, provide both electronic and paper submission options, and set clear criteria for exceptions. Health plans must respond to exception requests within 72 hours (or 24 hours in urgent cases), and if an exception is granted, the alternative medication must be covered for at least one year. Additionally, health plans are required to report annually to the Secretary of Labor detailed information about step therapy exception requests, including the number of requests received, approved, denied, and the reasons for denials. The provisions will apply to plan years beginning at least six months after the act's enactment, with the Department of Labor required to issue implementing regulations within six months of the act's passage.

Health and Social Services

https://www.congress.gov/bill/119th-congress/senate-bill/2903/all-info