Iowa Governor Terry Branstad Signs Law Improving Access to Step Therapy Exceptions

Law Removes Barriers that Prevent Patients from Accessing Safe, Timely and Effective Healthcare  

Portland, Ore. (May 10, 2017)—A coalition of organizations including the National Psoriasis Foundation (NPF) applauds the passage of Iowa House File 233 providing exceptions to step therapy in the state. Governor Terry Branstad (R) signed the measure into law today. The law, sponsored by Rep Tom Moore (R-Griswold), is a patient protection measure which requires that step therapy, or “fail first,” protocols be based on sound clinical evidence, not just cost, and allows for instances where an exception to step therapy must be granted by the insurer. The coalition supporting the legislation includes the NPF, Arthritis Foundation, Iowa Medical Society, American Cancer Society – Cancer Action Network (ACS-CAN), and The National Multiple Sclerosis Society.

Step therapy, or “fail first,” protocols allow a patient’s insurance company to require they try and fail on preferred medications before receiving the initial treatment prescribed by their doctor. While the preferred medication may be approved to treat that disease, it was not the first choice of treatment due to the patient’s disease history and treatment needs. In many cases, this required form of therapy is often not as effective as the one initially prescribed and may ultimately cause more hardship and cost for the patient. Requiring a patient to take a therapy that his or her health care provider does not think is the most appropriate for a prolonged period as they go through the step therapy process could lead to irreversible disease progression and other harmful side effects.

As a direct result of HF 233, starting in 2018, up to 30,000 individuals living with psoriatic disease may benefit from this new law. HF 233 provides patients and providers a clear path to being granted a step therapy exception by ensuring safety and transparency for both patients and health care providers.

“By passing strong patient protection bills like HF 233, we dramatically improve health outcomes for all living with psoriatic disease. Passing this law helps us increase the number of people receiving appropriate treatment, and reduces the number of individuals who report their psoriasis and psoriatic arthritis to be a problem in everyday life,” said MaryAnn McCabe NPF Midwest state government relations manager.

NPF played an integral part in the coalition behind the bill’s passing. The coalition attended negotiations with insurers, educated lawmakers on how the bill would directly improve patient’s health outcomes, engaged patient advocates, attended a meeting with the governor’s staff, and participated in a state lobby day which included meetings between patient advocates and their legislators to discuss how current step therapy laws were impacting a patients ability to effectively manage their disease.

With the passage of this bill, Iowa joins 15 other states including Indiana, Illinois, and New York, in reducing the burdens imposed by step therapy and facilitating the patient’s ability to get on the appropriate treatment prescribed by their health care provider in a timely manner. The adoption of this law in Iowa is an important milestone for patients in the state as well as for the NPF efforts to ensure treatment decisions remain between patients and their health care providers. Learn more about NPF step therapy advocacy efforts at


About the National Psoriasis Foundation

Serving its community through more than 50 years of patient support, advocacy, research, education, and funding, the National Psoriasis Foundation (NPF) is the world’s leading nonprofit fighting for individuals with psoriasis and psoriatic arthritis. The NPF mission is to drive efforts to cure psoriatic disease and dramatically improve the lives of more than 8 million individuals in the United States affected by this chronic immune-mediated disease. As part of that effort, NPF created its Patient Navigation Center to offer personalized assistance to everyone with psoriasis or psoriatic arthritis. To date, NPF has funded more than $21 million in research grants and fellowships that help drive discoveries that may lead to more and better treatments and ultimately a cure. Learn more at