United States 117th Congress Status: In Committee Bipartisan · 21 D · 14 R · 2 I cosponsors

S 464 — Safe Step Act

Last action — Read twice and referred to the Committee on Health, Education, Labor, and Pensions.

  1. ✓
    Introduced
  2. 2
    In Committee
  3. 3
    Passed Senate
  4. 4
    Passed House
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 117th Congress. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there are no live odds of enactment. It would have to be reintroduced in the current session to move again.

In plain language

The Safe Step Act improves insurance coverage for step therapy protocols in healthcare.

The Safe Step Act aims to ensure that patients can access necessary medications without unnecessary delays. It addresses step therapy practices that require patients to try cheaper alternatives before accessing prescribed treatments.

What this means for you
  • Healthcare: This means patients can receive prescribed medications faster, aligning treatment with their medical needs.

Summary

Safe Step Act 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. 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. 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.

Bill Text

How this bill changes current law

9 changes Share ↗

Compared against current U.S. Code AI-generated reading aid — verify against the official bill.

The bill adds a requirement for group health plans to establish an exceptions process for medication step therapy protocols.

  • 29 U.S.C. 1185b

    SEC. 713A. REQUIRED EXCEPTIONS PROCESS FOR MEDICATION STEP THERAPY PROTOCOLS.

    Creates a new section requiring an exceptions process for medication step therapy protocols.

  • 29 U.S.C. 1185b

    (a) In General.--In the case of a group health plan or health insurance coverage offered in connection with such a plan that provides coverage of a prescription drug pursuant to a medication step therapy protocol, the plan or coverage shall--

    Specifies that plans must implement a process for requesting exceptions to medication step therapy protocols.

  • 29 U.S.C. 1185b

    (1) implement a clear and transparent process for a participant or beneficiary (or the prescribing health care provider on behalf of the participant or beneficiary) to request an exception to such medication step therapy protocol, pursuant to subsection (b);

    Establishes a requirement for a clear process for exception requests.

  • 29 U.S.C. 1185b

    (2) where the participant or beneficiary or prescribing health care provider's request for an exception to the medication step therapy protocols satisfies the criteria and requirements of subsection (b), cover the requested drug in accordance with the terms established by the health plan or coverage for patient cost-sharing rates or amounts at the time of the participant's or beneficiary's enrollment in the health plan or health insurance coverage.

    Mandates coverage for drugs if exception criteria are met.

  • 29 U.S.C. 1185b

    (b) Circumstances for Exception Approval.--The circumstances requiring an exception to a medication step therapy protocol, pursuant to a request under subsection (a), are any of the following: ...

    Defines the circumstances under which exceptions to step therapy protocols can be approved.

  • 29 U.S.C. 1185b

    (c) Requirement of a Clear Process.--

    Outlines the requirements for the clarity and transparency of the exceptions process.

  • 29 U.S.C. 1185b

    (d) Timing for Determination of Exception.--The process required under subsection (a)(1) shall provide for the disposition of requests received under such paragraph in accordance with the following: ...

    Establishes timelines for processing exception requests.

  • 29 U.S.C. 1185b

    (e) Medication Step Therapy Protocol.--In this section, the term `medication step therapy protocol' means a drug therapy utilization management protocol or program ...

    Defines what constitutes a medication step therapy protocol.

  • 29 U.S.C. 1001

    Clerical Amendment.--The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 ... by inserting after the item relating to section 713 the following new items: `Sec. 713A. Required exceptions process for medication step therapy protocols.`.

    Updates the table of contents for the Employee Retirement Income Security Act to include the new section.

Action History

  1. Introduced in Senate

  2. Read twice and referred to the Committee on Health, Education, Labor, and Pensions.

Sponsors

Sponsorship breakdown

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1 sponsors · 36 co-sponsors · 510 not signed on

Sponsors (1)

Co-sponsors (36)

Not signed on (510)

510 members have not signed on to this bill.

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"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

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Subjects

healthcare health-insurance
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Frequently asked questions

What does S 464 do?
Safe Step Act 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. 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. 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.
Who sponsors S 464?
S 464 is sponsored by Murkowski, Lisa (Republican), Hassan, Margaret Wood (Democratic), Cassidy, Bill (Republican), Rosen, Jacky (Democratic), Hyde-Smith, Cindy (Republican), Gillibrand, Kirsten E. (Democratic), Sinema, Kyrsten (Independent), Capito, Shelley Moore (Republican), Hirono, Mazie K. (Democratic), Tillis, Thomas (Republican), Shaheen, Jeanne (Democratic), Cramer, Kevin (Republican), Merkley, Jeff (Democratic), Blumenthal, Richard (Democratic), Marshall, Roger (Republican), King, Angus S., Jr. (Independent), Bennet, Michael F. (Democratic), Collins, Susan M. (Republican), Smith, Tina (Democratic), Scott, Tim (Republican), Tester, Jon (Democratic), Casey, Robert P., Jr. (Democratic), Boozman, John (Republican), Moran, Jerry (Republican), Lummis, Cynthia M. (Republican), Wicker, Roger F. (Republican), Cortez Masto, Catherine (Democratic), Warnock, Raphael G. (Democratic), Stabenow, Debbie (Democratic), Van Hollen, Chris (Democratic), Peters, Gary C. (Democratic), Carper, Thomas R. (Democratic), Kelly, Mark (Democratic), Portman, Rob (Republican), Kaine, Tim (Democratic), Feinstein, Dianne (Democratic), and Heinrich, Martin (Democratic).
What is the current status of S 464?
This bill died with 117th Congress. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track S 464?
Track S 464 free on One Click Politics — get push/email alerts when it moves.

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