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February 22, 2019

NPAF Advocates Cheer as Step Therapy Regulations Pass in Virginia

Richmond, VA – The VA House of Delegates today passed legislation regulating the use of step therapy by insurers, a move applauded by advocates for putting patients and their physicians better in control of their own treatment plans.


House Bill 2126 reforms step therapy, or “fail first” protocols, in which patients must try an inexpensive treatment before insurers will cover a more expensive one, even when providers are confident that the inexpensive treatment will not work. HB 2126, introduced by Delegate Glenn Davis (R-Virginia Beach), improves step therapy protocols by creating an expedited, transparent and evidence-based system when a patient’s unique situation requires a deviation from step therapy.


“We’ve seen the direct impact that bad step therapy protocols can have on the lives of patients and their families. We’ve worked with patients who have had to restart on treatment protocols that haven’t worked for them each time they switched insurers, pushing back their recovery and resulting in job losses, health deterioration and financial ruin. While we understand—and support—reasonable step therapy protocols to keep systemic costs low, there must always be humanity in the protocols so that patients are not denied the treatment that has the best possible chance at curing them,” said NPAF CEO Alan Balch, PhD. “This legislation is great news for people throughout Virginia.”



NPAF worked with Fair Health VA, a coalition of patient, provider, and health care groups committed to securing access to life-saving treatments for Virginians, particularly those with chronic conditions. NPAF volunteers, along with patients from sister organization Patient Advocate Foundation headquartered in Hampton, championed this issue in Richmond and within their home offices, sharing their stories as examples of the negative effects that step therapy protocols can have when improperly utilized.


Governor Northam must sign the bill before it becomes law. Once he does, Virginia will become the 20th state to pass regulations on step therapy protocols.