I write to request your support for AB 4815/S 305 which will protect patients by reforming step therapy requirements mandated by health insurance companies. Step therapy, also known as “fail first,” is a health insurance protocol used to manage the cost of medications. It forces patients to try and fail one or more insurer-preferred medications, proving their ineffectiveness to the patient, before receiving coverage for the medication their physician recommends. If a patient ends up changing their health insurance plan, or a medication they are currently using is moved to a non-preferred status during a coverage year, that patient may be put through the step therapy process again. Physicians can request exceptions to step therapy requirements, but insurers may not respond promptly to such requests. This process can take weeks to months, resulting in patients not being able to access the medications they need, leading to worsened symptoms and disease progression. Additionally, by limiting medication options, both doctors and patients are forced to compromise their treatment decisions in a way that is dangerous, time consuming and more expensive in the long-term. Asthma medications are especially prone to step therapy because health plans frequently change the list of preferred medicines they cover. Currently, there are 30 states that have passed step therapy amendments. These amendments have not banned step therapy, but instead established guardrails, striking a fair balance between cost containment and patients’ health. This legislation will similarly implement common-sense reforms to the rules that insurance companies must abide by when utilizing step therapy protocols. I thank you for your consideration, and I hope this legislation becomes law to protect and improve the lives of those with asthma, allergies and related conditions.

I write today to request your support for AB 4815/S 305 which will protect patients by reforming step therapy requirements mandated by health insurance companies. Step therapy, also known as “fail first,” is a health insurance protocol used to manage the cost of medications. It requires patients to try and fail one or more insurer-preferred medications, proving their ineffectiveness to the patient, before receiving coverage for the medication their physician recommends. If a patient ends up changing their health insurance plan, or a medication they are currently using is moved to a non-preferred status during a coverage year, that patient may be put through the step therapy process again. Physicians can request exceptions to step therapy requirements, but insurers may not respond promptly to such requests. This process can take weeks to months, resulting in patients not being able to access the medications they need, leading to worsened symptoms and disease progression. Additionally, by limiting medication options, both doctors and patients are forced to compromise their treatment decisions in a way that is dangerous, time consuming and more expensive in the long-term. Asthma medications are especially prone to step therapy because health plans frequently change the list of preferred medicines they cover. Currently, there are 30 states that have passed step therapy amendments. These amendments have not banned step therapy, but instead established sensible guardrails, striking a fair balance between cost containment and patients’ health. This bill will similarly implement reforms to the rules that insurance companies must abide by when utilizing step therapy protocols. Thank you for your thoughtful consideration, and I hope this legislation becomes law to protect and improve the lives of those with asthma, allergies and related conditions.