Virginia Passes Step Therapy Reform Bill into Law

National Psoriasis Foundation Leads Coalition of Advocacy Organizations to Pass New Law

Portland, Ore. (March 13, 2019)—The National Psoriasis Foundation, NPF along with more than twenty other patient and provider advocacy organizations associated with the Fair Health VA coalition applaud Virginia lawmakers for passing H.B. 2126 into law. The law requires health insurers to establish a process for step therapy override exception guidelines.

Step therapy or “fail first” protocols allow a patient’s insurance company to require they try and fail on certain medications before receiving the initial treatment prescribed by their health care provider. While in some cases step therapy can successfully control costs, the 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 appropriate treatment could result in increased disease activity, loss of function and possible irreversible progression of the disease.

Led by Delegate Glenn R. Davis Jr. (R) District 84 and with unanimous support from both the House and Senate the passage of H.B. 2126 will provide Virginia patients more timely access to the medications initially prescribed by their health care providers. The law will go into effect on January 1, 2020.

"I am thrilled that Governor Northam has agreed with the General Assembly that all Virginians, especially those with chronic, complex and/or disabling conditions, deserve a faster and more efficient process to access the prescribed therapies they and their physicians decided were most appropriate,” said Harry L Gewanter, MD., a Richmond VA pediatric rheumatologist, and Fair Health VA advocate. “This legislation will ensure that one more barrier to patient-centered personalized treatment is eliminated in Virginia. We look forward to the effective implementation of this legislation as it will result in reduced frustration by patients, reduced administrative overhead for physicians and reduced costs to the Commonwealth.”

NPF has been pursuing this issue in Virginia for nearly four years and played an integral role in the bill’s passing. Working with a coalition of more than twenty organizations, including National Patient Advocate Foundation, Arthritis Foundation, and National Multiple Sclerosis Society, NPF created step therapy override exception rules and met with key lawmakers throughout the last three legislative sessions to educate and negotiate the issue. NPF also mobilized patient advocates to support the campaign and compiled data on step therapy.

The adoption of this law in Virginia is an important milestone for patients in the state, as well as for NPF efforts to ensure patients have timely access to the most appropriate treatments.

“This is an important measure that will improve the lives of Virginia residents who suffer from psoriasis and psoriatic arthritis,” said NPF advocate Stephen Keat. “I am grateful that members of both parties understand the importance of these patient protections and unanimously supported step-therapy reform.”

This is the second step therapy reform legislation signed into law in 2019. With the passage of this bill, Virginia joins 19 other states including Texas, New Mexico, Iowa, Indiana, Illinois, and New York, in reducing the burdens imposed by step therapy and facilitating patients’ ability to access the appropriate treatment prescribed by their health care provider in a timely manner.

NPF continues to work on behalf of all patients living with psoriasis or psoriatic arthritis that cannot afford to delay access to the effective treatments prescribed by their health care provider. Placing patient protections around step therapy protocols will assist NPF to improve health outcomes for the more than 8 million Americans living with psoriasis and psoriatic arthritis. To learn more about how NPF works to reform step therapy 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