Treatments for rheumatic diseases like arthritis and lupus are not “one size fits all” and must be carefully tailored to a patient’s unique condition and needs. These treatment decisions are overridden by step therapy, a process that forces patients to try and fail insurer-preferred treatments before the intended prescription is approved – even if the imposed treatment is known to be ineffective.

Step therapy disrupts timely access to rheumatology treatment for the financial benefit of pharmacy benefit managers (PBMs), who profit from the placement of pharmaceuticals on the formularies which drive step therapy algorithms. Step therapy guardrails are essential to bring patient-centered transparency to PBM’s and their financial relationship to the formulary decisions which drive step therapy.

The ACR supports legislation that would reform step therapy protocols. Congress needs to hear from you, so take a moment to send your message today!