Patients could appeal insurer step therapy rules within 72 hours
In committeeH.R. 5509Latest action
Sponsor: Rick W. Allen · Representative · GA
AIDecoded by AI · checked against the recordRead the official text
Official title: Safe Step Act
119th Congress
Topics: Health care
Introduced:
Read the official bill on Congress.govIn plain words
The plain-language version comes first. The official text is always the reference.
Employer health plans would have to let patients skip "step therapy" drug requirements under certain conditions and respond within 72 hours.
50-second read · 4 questions answered below
What does this do?
This bill sets rules for employer-sponsored health plans that require patients to try cheaper drugs before covering the one their doctor prescribed. Plans would need a formal process for patients or doctors to request an exception, with a response required within 72 hours, or 24 hours in urgent situations. Exceptions must be approved when prior drugs failed, are unsafe, or when delay could cause serious harm, and approved coverage must last at least one year.
Who does it affect?
This affects patients enrolled in employer-sponsored health insurance plans and the doctors who treat them. Health plans covered by this bill would also be required to report exception data annually to the federal government.
Why does it matter?
Without a required exception process, patients whose doctors prescribed a specific drug may face delays or denials getting that medication. This bill would create a legal requirement for plans to respond and decide within set time limits.
AI-drafted summary. Check it against the official text before you act on it.
Read the official bill on Congress.govMake the call
Where does it stand?
- IntroducedSep 19, 2025
- House committeeYou are here · Sep 19, 2025
- House vote
- Senate
- The president's desk
Right now: a House committee is reviewing it. If the Senate changes it, it goes back to the House before reaching the president.
Latest action: — Referred to the House Committee on Education and Workforce.