National Psoriasis Foundation Improved Step Therapy Protocols in 12 States

In 2018 NPF Aims to Advance Step Therapy Legislation in 10 More States

Portland, Ore. (January 22, 2017) — The National Psoriasis Foundation (NPF) announces that after three years of working to protect psoriatic disease patients from step therapy practices, legislative advances have been made in 12 states, and the Foundation is targeting 10 states for step therapy protections in 2018. Due to NPF advocacy efforts, in states where protections have passed more than 2 million Americans living with psoriatic disease now have the opportunity to access better healthcare.

Step therapy, or “fail first,” is a policy developed by insurers intended to control costs. These policies allow a patient’s insurance company to require they try and fail on one or more medications before receiving the initial treatment prescribed by their doctor. While in some instances, step therapy may control costs, overall this practice can do more harm than good. For patients living with serious or chronic illnesses like psoriasis or psoriatic arthritis, prolonging ineffective treatment and delaying access to the medication their doctor thinks is best to treat their disease could result in increased disease activity, loss of function and possible irreversible disease progression.

“I have seen the devastating impact step therapy can have on patients with long-term psoriasis and psoriatic arthritis,” said Colby Evans, M.D., dermatologist at Evans Dermatology Partners in Austin, Texas, and past chairman of the NPF board of directors. “In most cases, I have the tools available to make patients dramatically better; however, it is harder for me to get those treatments to my patients with strict step therapy protocols.”

NPF step therapy efforts do not prohibit insurers from using cost control measures, rather they focus on securing patient protections that include providing an exemption process when a state’s step therapy protocol is harmful or unnecessary, and guaranteeing that exemption requests are approved by insurance companies in a timely manner. NPF is dedicated to ensuring that step therapy practices are based on the most current clinical evidence available and that annual decisions about which drugs are included in formularies are based on science, not cost. By securing step therapy protections, patients are able to access the initial treatments prescribed by their health care provider in a timely manner.

“I have experienced unnecessary pain and disease progression due to step therapy protocols preventing me from accessing treatments my doctors prescribed,” said NPF Volunteer Melissa Leeolou. “I am relieved to live in New York where the NPF has been successful influencing legislators to do the right thing and pass protections and exceptions that enable me and anyone with a chronic disease to access the effective treatments our health care providers prescribe.”

Working in coalition with various partners, to date NPF has pursued step therapy legislation in nearly two dozen states and has been successful in passing laws in California, Texas, Iowa, Missouri, Illinois, Indiana, West Virginia, New York, Connecticut, Kansas, Maryland and Colorado. Six of the twelve states’ legislative changes became effective January 1, 2018, while the remaining six states implemented protective step therapy protocols between 2014 and 2018. To learn details about each states step therapy laws, visit

In 2018, NPF will focus its efforts in 10 states, including Massachusetts, Maine, Minnesota, Georgia, Ohio, Washington, Utah, New Mexico, Virginia and Florida. Learn how you can help NPF achieve success in these states, and many others at

The NPF advocacy team is both a thought leader and direct, on-the-ground leader of coalitions in what has become a nationwide campaign to pass legislation that provides exceptions to step therapy protocols. This common sense and bi-partisan legislation seeks to put the power of prescribing medications back in the hands of the physician and restores the importance of personalized care by affirming the physician and patient relationship is the core driver of treatment decisions. To learn more about step therapy and how you can get involved, visit

NPF works on a number of issues concerning access to care in the states. Driven by the NPF medical board Access to Care statement, we are able to elevate the patient and provider voice on a number of issues at the forefront of health care policymakers’ agendas. This includes advocating for policy solutions to access to care issues including step therapy and prior authorization, high out of pocket costs, biosimilar substitution, switching stable patients off therapies, and legislation that seeks to limit access to patient assistance programs. To learn more about all NPF advocacy efforts visit

About the National Psoriasis Foundation

Serving its community through more than 50 years of patient support, advocacy, research funding, and education, 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 Americans 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