Overview
Step Therapy is an insurance protocol where patients are forced by their insurance provider to try cheaper drugs before the ideal medication or treatment available to the patient.
Step Therapy can result in delayed treatment and worse health outcomes for older adults living with cardiovascular disease, high cholesterol, and/or diabetes, during the time that they are forced to try less effective but cheaper treatments.
Why Step Therapy Disproportionately Harms Latino Older Adults?
Delayed Treatment: Fail-first requirements delay access to the right medication, which increases the risk of disease progression and preventable hospitalizations.
Higher Cardiovascular Risk: Attempting less-effective treatments first can exacerbate the management of high cholesterol, diabetes, and hypertension, thereby raising the risk of heart attacks and strokes, which are potentially fatal.
Loss of Clinical Judgement: Step Therapy places insurer cost controls over provider expertise, limiting patient–provider decision-making.
Language and Access Barriers: Complex rules make it harder for older Hispanic adults with limited English proficiency or health literacy to secure necessary approvals, resulting in a systemic barrier to proper healthcare.
Financial Strain and Distrust: Added costs and repeated delays can lead to non-adherence to medication and erode trust in the healthcare system.
NHCOA’s Policy Solution: Passage of the Safe Step Act.
NHCOA supports the passage of the Safe Step Act. This piece of legislature aims to reform Step Therapy practices by ensuring that insurance policies cannot override medical expertise, and that patients can access the treatments their providers deem necessary.
How does it work?
The Safe Step Act amends the Employee Retirement Income Security Act (ERISA) to require group health plans to adopt a clear, transparent, and timely exception process for step therapy protocols.
Required Exceptions to Fail-First Protocols
Under the Safe Step Act, an exception must be granted if:
1. The patient has already tried and failed the medication required by Step Therapy practices.
2. Delaying effective treatment would result in severe or irreversible harm.
3. The required medication is contraindicated or likely to cause an adverse reaction.
4. The medication would prevent the patient from working or performing activities of daily living (ADLs), such as eating, bathing, dressing or transporting.
5. The patient is stable on their current medication, which was previously covered by an insurance plan.
Why is it important?
By restoring clinical decision-making power to patients and providers, the Safe Step Act addresses the barriers that contribute to poor cardiovascular outcomes among Latino older adults. The legislation promotes equal access to care, minimizes treatment delays, and helps to prevent avoidable complications that arise from the mismanagement of chronic diseases.
NHCOA urges members of Congress to advance and pass the Safe Step Act (H.R. 5509/S. 2903) to ensure that older adults and all individuals living with chronic conditions have timely access to medically appropriate treatments.
References:
2024 Status of Hispanic Older Adults Annual Report: Insights from the Field – Elevating Heart Health Awareness & Advocacy. https://nhcoa.org/wp-content/uploads/2024/09/NHCOAs-2024-SHOAR Report.pdf
2025 Status of Hispanic Older Adults Annual Report Insights from the Field: Advancing Health Equity Through Access, Awareness, and Prevention. https://nhcoa.org/wp content/uploads/2025/12/NHCOAs-2025-SHOAR-Report.pdf
H.R. 5509/ S. 2903, SAFE STEP ACT. https://steptherapy.com/wp-content/uploads/2025/11/Safe-Step Act-Endorsement-Letter_092625.pdfn
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