119-S-2903 Journalist Public Summary
A bipartisan Senate bill would require employer health plans that use "step therapy" (try-cheaper-first rules) to offer a fast, clear medical exceptions process—72 hours normally, 24 hours for urgent cases—with approvals lasting at least a year. Supporters say it reduces harmful delays and protects continuity of care; opponents warn of higher costs and weaker formulary controls. As of March 19, 2026, it has held a Senate HELP Committee hearing and awaits further action.
Public Summary: S. 2903 — Safe Step Act (119th Congress)
Headline Summary: The Safe Step Act would make employer health plans that use “step therapy” provide a quick, transparent way for patients and doctors to get exceptions when those try‑this‑first rules aren’t medically appropriate.
What It Does: The bill amends ERISA to require group health plans to set up a clear exceptions process for step‑therapy policies. Patients or their doctors could request an override when, for example, the required drug already failed, is likely to cause harm, is contraindicated, would meaningfully limit daily functioning or work, the patient is stable on a different drug, or delaying care risks serious consequences. Plans must decide within 72 hours (24 hours if urgent), approvals must last at least one year, and plans must use standard forms, allow electronic submissions, and report annual data to the Department of Labor.
- Who’s For It: Bipartisan Senate sponsors, led by Sens. Lisa Murkowski (R‑AK) and Maggie Hassan (D‑NH), plus a cross‑party group of co‑sponsors.
- Who’s For It: Many patient and provider organizations that argue step‑therapy delays can worsen conditions and that predictable exceptions protect continuity of care and reduce avoidable ER visits or hospitalizations.
- Who’s For It: Some rare‑disease, oncology, rheumatology, dermatology, and mental‑health advocates who emphasize individualized treatment and prior stability on a medication.
- Who’s Against It: Health insurers and pharmacy benefit managers (PBMs) that warn broader exceptions could weaken formulary management, raise drug spending, and push up premiums for employers and workers.
- Who’s Against It: Some employer groups concerned about administrative burden, potential for overuse of branded drugs when lower‑cost options might work, and added reporting requirements.
What’s Next: The bill was introduced on September 18, 2025, and held a hearing in the Senate Health, Education, Labor, and Pensions (HELP) Committee on March 19, 2026. Next steps could include a committee markup and vote. If it passes the Senate, it would need House approval and the President’s signature to become law.
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