This bill would require health insurance plans to allow exceptions to their medication step-therapy protocols in certain cases, such as if the required treatment is ineffective or likely to cause an adverse reaction. It sets timelines for plans to respond to requests for these exceptions.
Latest Action
Referred to the House Committee on Education and the Workforce.
AI Summary
Plain-English explanation of this bill
This bill would require health insurance plans to allow exceptions to their medication step-therapy protocols in certain cases, such as if the required treatment is ineffective or likely to cause an adverse reaction. It sets timelines for plans to respond to requests for these exceptions.
Last updated: 12/29/2025
Official Summary
Congressional Research Service summary
<p><strong></strong><b>Safe Step Act</b></p> <p>This bill requires a group health plan to establish an exception to medication step-therapy protocol in specified cases. A medication step-therapy protocol establishes a specific sequence in which prescription drugs are covered by a group health plan or a health insurance issuer. </p> <p>A request for such an exception to the protocol must be granted if (1) an otherwise required treatment has been ineffective, (2) such treatment is expected to be ineffective and delaying effective treatment would lead to irreversible consequences, (3) such treatment will cause or is likely to cause an adverse reaction to the individual, (4) such treatment is expected to prevent the individual from performing daily activities or occupational responsibilities, (5) the individual is stable based on the prescription drugs already selected, or (6) there are other circumstances as determined by the Employee Benefits Security Administration.</p> <p>The bill requires a group health plan to implement and make readily available a clear process for an individual to request an exception to the protocol, including required information and criteria for granting an exception. The bill further specifies timelines under which plans must respond to such requests.</p>
Key Points
Main provisions of the bill
Allows exceptions to medication step-therapy protocols in specified cases, such as if the required treatment is ineffective or harmful
Requires health plans to have a clear process for individuals to request these exceptions
Sets timelines for health plans to respond to exception requests
How This Impacts Americans
Potential effects on citizens and communities
This bill would affect individuals who are enrolled in group health insurance plans and have been denied coverage for a medication their doctor prescribed due to the plan's step-therapy protocol. If passed, these patients would have an easier path to get the treatment their doctor believes is best for their health.
Policy Areas
Primary Policy Area
Health
Related Subjects
Drug therapy
Employee benefits and pensions
Health care costs and insurance
Health care coverage and access
Prescription drugs
Scope & Jurisdiction
Jurisdiction Level
federal
Congressional Session
119th Congress
Citation Reference
2630, 119th Congress (2025). "Youth Suicide Prevention Research Act". Source: Voter's Right Platform. https://votersright.org/bills/118-hr-2630
