On January 22, 2026, five CEOs of the largest health insurance companies in the country appeared before the House Energy & Commerce Committee to talk about rising health care costs, reduced access, and the role their policies play in making health care unaffordable for many Americans. In this hearing, Congressman Troy Carter of Louisiana highlighted the problems with one common health insurance practice known as step therapy, or “fail-first.” At the end of his question period, Congressman Carter asked the CEOs to be a “buffer for patients” and got all five CEOs to agree to reform the practice of step therapy.
As many people living with chronic conditions know, step therapy is a complex prior authorization protocol that requires patients to try and fail insurer-preferred treatments before covering the treatment selected by the patient and their provider. Despite claims that step therapy saves money, there is mounting evidence that any savings to prescription drug costs are eclipsed by increased health care utilization, while causing serious delays in care that lead to devastating negative health effects.
Today, the Safe Step Ad Hoc Coalition, a broad alliance representing millions of patients with life-threatening, complex chronic conditions and the physicians who care for them, called on the five CEOs to provide an update on the actions they’ve taken to support their pledge to Congress and the American people to reform step therapy. These letters asked for details on the specific actions they have taken or plan to take (and when these plans will be enacted) and urged them to be a leader in patient-centered care. We also outlined the Coalition’s key concerns with step therapy as it is used today:
- Clinical Degradation: Step requirements frequently contradict current established medical guidelines for patient care, and by the time a patient has proven failure and allowed to “step up” to the prescribed medication, their condition has worsened to the point of requiring surgery or hospitalization.
- Erosion of the Patient-Provider Relationship: Step therapy protocols undermine physician expertise, eroding trust and delaying care.
- Economic Inefficiency: Step therapy frequently leads to higher overall health care costs through increased emergency room visits, negative health outcomes, and lost workplace productivity.
The letter highlighted the growing bipartisan support for the Safe Step Act (H.R. 5509/S. 2903), and a shifting health care landscape towards a mandatory exceptions process and transparent oversight. The Coalition recommended each CEO consider implementation of the streamlined, medically sound, and transparent exceptions process for step therapy protocols contained in the Safe Step Act. This process is supported by more than 200 patient and provider advocacy organizations and brings patient-centered decision-making back to the heart of health care delivery.
Please stand with the Safe Step Ad Hoc Coalition and the millions of patients and providers we represent and hold these CEOs accountable to their commitments. Ask them to deliver on their promise to put patients over profits and reform step therapy. Call your representatives today and tell them to support the Safe Step Act. Together, we can make a difference in reducing delays, cutting bureaucratic red tape, and bringing medical decision-making back to the patients and their trusted providers.
