53 Patient and Provider Groups Ask Congress for Step Therapy Guardrails in Future COVID-19 Relief Legislation

Portland, Ore. (April 23, 2020)— 53 patient and provider groups, led by the National Psoriasis Foundation, NPF, circulated a letter to congressional leadership in both the U.S. House of Representatives and Senate asking Congress to include guardrails for the use of step therapy protocols in future COVID-19 relief legislation.

Thanks to recent efforts by Congress and the Administration, patients have already received several protections to ensure that they have access to health care despite the enormity of the COVID-19 pandemic. Previously enacted statutory or regulatory changes have significantly expanded the use of telehealth, reduced face-to-face provider requirements, enabled providers to seamlessly practice across state lines, and lifted restrictions allowing patients to receive care at out-of-network or non-contracted facilities. While these measures have been critical in ensuring patients have access to health care and their medications during this time, further steps should be taken.

The letter urges Congress take additional action to support access to care by ensuring appropriate use of step therapy in Medicare Advantage (MA)Medicare Prescription Drug (PDP)Medicaid Managed Care (MCO) and ERISA plans. Instituting step therapy guardrails and protections for all MA, PDP and Medicaid MCO plans and ERISA plans governed by the Department of Labor is critical during this public health emergency. It is asked that all MA, PDP, Medicaid MCO and ERISA plans that have step therapy policies be required to make those policies clear, readily accessible, and visible to all members.

Additionally, it is requested that Congress require all plans to provide timely responses to requests for step therapy exemptions, including both regular and emergency requests, and to enumerate a specific set of criteria that would warrant an exemption from any step protocol. Examples would include situations in which a patient has been stable on a drug for an extended period of time and where switching medications would jeopardize this stability, when a drug is contraindicated or when a patient has already tried and failed a drug they are being asked to step through.

Lastly, Congress is urged to enact these same protections outside of the public health emergency for a minimum of one year after the end date of the emergency.

Organizations signing the letter include; Allergy & Asthma Network, Alliance for Balanced Pain Management, Alliance for Patient Access, ALS Association, American Academy of Dermatology Association, American Academy of Neurology, American College of Rheumatology, American Diabetes Association, American Gastroenterological Association, American Liver Foundation, Arthritis Foundation, Association for Clinical Oncology, Cancer Support Community, Caregiver Action Network, Chronic Disease Coalition, Crohn's & Colitis Foundation, Depression and Bipolar Support Alliance, Derma Care Access Network, Dystonia Medical Research Foundation, Epilepsy Foundation, GBS|CIDP Foundation International, Good Days, Hawai'i Parkinson Association, Headache and Migraine Policy Forum, Hemophilia Federation of America, Hypersomnia Foundation, International Foundation for Gastrointestinal Disorders, Interstitial Cystitis Association, ITSAN  Non Profit, Lupus and Allied Diseases Association, Inc., Lymphatic Education & Research Network, Mental Health America Movement Disorders Policy Coalition, National Alliance on Mental Illness, National Alopecia Areata Foundation, National Eczema Association, National Infusion Center Association, National Multiple Sclerosis Society, National Organization for Rare Disorders, National Pancreas Foundation, National Patient Advocate Foundation, National Psoriasis Foundation, NephCure Kidney International, Project Sleep, Pulmonary Hypertension Association, Scleroderma Foundation, The Marfan Foundation, Tourette Association of America, United for Charitable Assistance, US Hereditary Angioedema Association, U.S. Pain Foundation, Vision Health Advocacy Coalition.

NPF continues to work on behalf of all people living with psoriasis or psoriatic arthritis that cannot afford to delay access to the effective treatments prescribed by their health care provider. For more information on this letter and NPF advocacy efforts, please contact Patrick Stone pstone@psoriasis.org. To learn more about how NPF works to reform step therapy visit www.steptherapy.com.

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