END "FAIL FIRST"
Patients deserve access to the treatment their providers determine is right for them. End Fail First helps patients understand step therapy and gives them the tools to challenge barriers standing between them and prescribed care.
What Is
‘Fail First’?”
Fail first,” formally known as step therapy, is an insurance practice that requires patients to try an insurer-preferred treatment before receiving coverage for the treatment originally prescribed by their healthcare provider.
Your doctor prescribes Treatment B.
Your insurer requires you to try Treatment A first.
Even if your provider believes Treatment B is more appropriate, coverage may be denied until you try Treatment A or receive an exception.
That required step is step therapy.
40%
of patients reported that step therapy led them to stop taking their medication altogether, according to a national patient survey by the Global Healthy Living Foundation.
OUR CAMPAIGN:
TAKE ACTION
We're calling for stronger protections that allow patients and their providers to bypass step therapy when an insuer-required treatment is medically inappropriate. A teatment decision should reflect a patient's medical history and their provider's judgement, not require unecessary failure before another option can be covered.
RESOURCES
BE INFORMED
JOIN US TO END FAIL FIRST:
01 — WRITE TO YOUR REPRESENTATIVES
Your representatives have the power to support legislation that protects patients from harmful step therapy requirements. Use our outreach template to ask your representatives to champion step therapy reform and make your voice part of the push to End Fail First.
02 — BRING END FAIL FIRST TO YOUR COMMUNITY
Help more patients understand what step therapy is and why reform matters. Our campaign toolkit gives you ready-to-share resources to bring End Fail First to your school, organization, or online community.
03 — JOIN THE SOCIAL CAMPAIGN
Bring End Fail First into the conversations already happening in your community. Share campaign materials using #EndFailFirst, tag Chronically Me, and help us make step therapy a barrier more patients know they can challenge.
04 — TELL YOUR STORY
Your experience with step therapy can help show what “fail first” looks like beyond policy language. Tell us how step therapy affected your care and help bring patient experiences into the push for reform.
WRITE TO YOUR REPRESENTATIVES
The Safe Step Act is bipartisan federal legislation designed to make it easier for patients to receive an exception from step therapy requirements when “failing first” is not medically appropriate.
End Fail First is calling on members of Congress to support the Safe Step Act and help move these protections forward.
THE SAFE STEP ACT
-
Establishes a clear process for patients to request an exception to step therapy requirements.
-
Requires affected health plans to grant exceptions in specified circumstances, such as when a required treatment is expected to be ineffective or has previously been tried.
-
Sets timelines for insurers to respond to exception requests.
-
Creates federal protections for patients covered by certain employer-sponsored health plans.
RESOURCES
Use this customizable template to challenge a step therapy denial and make the case for coverage of the treatment your provider prescribed.
APPEAL A DENIAL TEMPLATE
PREPARING FOR A STEP-THERAPY CONVERSATION
EXPLORE STEP THERAPY ADVOCACY
STEP THERAPY RIGHTS GUIDE
A plain-language guide to what step therapy is, when an exception may be available, what to look for in your insurance plan, and what protections may apply.
Organize your treatment history and prepare for a conversation with your provider about requesting a step therapy exception.
Explore research and patient perspectives on step therapy, with resources for learning more about the movement for reform.
READ
“The Fight for Step Therapy Reform Is Personal” — Arthritis Foundation.
The Safe Step Act — Safe Step Coalition.
Research on Step Therapy and Healthcare Use — PubMed
WATCH
Understanding Step Therapy
Step Therapy: An Obstacle Course to Optimal Health
Step therapy requires patients try alternate medication
LISTEN
"Making the Safe Step Act a Reality" with Andrea Hans, Breast Cancer Survivor & Health Advocate
"Explain This to Me: Self-Advocacy, From a Doctor’s Office to Capitol Hill”
"What is Step Therapy and How Does it Affect Cancer Patients?" with Dr. Keith Crawford, MD, Ph.D.