Nebraska Passes Step Therapy Reform to Improve Patient Protections

LB 337 establishes clear guardrails in step therapy process.

Portland, Oregon – April 1, 2021

The National Psoriasis Foundation (NPF) applauds Nebraska Governor Pete Ricketts and the Nebraska Legislature for the unanimous passage of Legislative Bill 337 (LB 337). LB 337 expands access to care to over 46,000 Nebraskans living with psoriatic disease.

Prior to the passage of LB 337, Nebraskans may be subjected to step therapy or "fail first” policies. These policies are tools that health insurance companies use to evaluate the medical necessity or appropriateness of medications for specific diseases and conditions. Sometimes these policies require that individuals fail on one or more therapies before granting approval for the medication their health care provider originally prescribed.  Step therapy often results in significant delays in treatment, placing patients at risk for loss of function, increased disease activity and potentially irreversible progression or disability.

Legislative Bill 337 requires state regulated health plans and the state employee plan to provide a clear process for a health care provider or patient to request an exception to the step therapy protocol. Insurers are required to reply within 72-hours for emergency exception requests, or five business days for non-emergency exception requests.

Patients will be granted exceptions if: treatments are contraindicated or will likely cause an adverse reaction or harm to the patient, treatments are expected to be ineffective, the patient has already tried the treatment and it was discontinued due to lack of efficacy, the treatment is not in the best interest of the patient, or the patient is stable on their current treatment.

Sponsored by Senator Mark Kolterman, LB 337 unanimously passed the third and final round of floor debate on March 25, 2021 with a vote of 47-0 and will take effect after January 1, 2022. Nebraska becomes the 2nd state to pass step therapy reform in 2021 and the 29th state to do so overall.

NPF was actively engaged on the ground in Nebraska to represent the interests of people with psoriatic disease. Nearly 50 patient and provider organizations worked together to support the passage of this bill. NPF state government relations manager for the central region, Kristen Stiffler, led the patient-provider coalition and provided socially-distanced in-person testimony for the Banking Commerce and Insurance Committee hearing.

“We especially want to thank Senator Mark Kolterman and Chairman, Senator Matt Williams, for their leadership and guidance,” says Stiffler. “They brought all stakeholders together, including the provider community, health plans, pharmacy benefit managers, and patient organizations to work on this important legislation that will put necessary patient protections in place and improve the step therapy process for Nebraskans.”

NPF continues to work on behalf of all people living with psoriasis and psoriatic arthritis who 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, 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 $24 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



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