Poll Of 1,400 Likely Voters Finds Bipartisan Opposition To Insurers’ Step Therapy Mandates, With Voters Overwhelmingly Trusting Their Own Doctors Over Their Insurance Companies
WASHINGTON, D.C. (September 22, 2026) — The Safe Step Coalition, an alliance of more than 225 patient and clinician advocacy organizations co-chaired by the Arthritis Foundation and the National Psoriasis Foundation, released a new national poll today finding overwhelming, bipartisan support for federal reform of step therapy protocols, with nearly four in five likely voters (78%) supporting reforms in the Safe Step Act, bipartisan legislation that would provide patients and their providers a clear, timely process to appeal an insurer’s step therapy requirement. The national poll also finds that support for step therapy reform holds strong across party lines, with 78% of Republicans, 80% of Democrats and 75% of independents supporting the reforms in the Safe Step Act.
The poll, conducted by McLaughlin & Associates on behalf of the Safe Step Coalition, polled 1,400 likely voters nationwide between August 22 and August 25, 2026. The poll’s central finding is that once voters understand what step therapy is, they reject it decisively:
- 70% of polled likely voters oppose insurance companies enforcing step therapy mandates, and nearly half of all voters (49%) are strongly opposed.
- 90% of polled likely voters said they trust their own doctor more than their insurance company to decide which medication is right for them.
“Treating and managing complex chronic disease requires a personalized and comprehensive strategy, but more and more people across the country must work through one-size-fits-all step therapy protocols before accessing the medicine their clinician knows is right for them,” said Leah McCormick Howard, President and CEO of the National Psoriasis Foundation. “This national poll affirms what patients, clinicians, and bipartisan legislators have been saying for years: it is time for federal reform that protects patients and the treatment decisions their doctors make. Congress should heed the calls of patients, clinicians, and likely voters and advance the Safe Step Act to restore treatment decisions to where they belong, between a patient and their healthcare professional.”
“Members of Congress often ask us whether voters actually care about step therapy. The overwhelming answer is not only yes, but that a vast majority of likely voters oppose the harmful insurance practice,” said Steven Taylor, President and CEO of the Arthritis Foundation. “Voters are not just sympathetic, they are ready to hold legislators accountable for how they vote. The Safe Step Act is a commonsense, bipartisan fix that guarantees patients a clear, timely exemption process when the protocol is hurting them.”
The national poll on step therapy also found that:
- 83% of likely voters live in a household where someone regularly takes a prescription medicine.
- 32% said an insurance company has denied them or a family member coverage for a prescription drug or forced them onto an alternative instead of the drug their doctor prescribed, rising to 37% among households that regularly take prescription medication.
- 77% are concerned the same thing could happen to them, including 50% who are extremely or very concerned.
“More than 90% of physicians report that prior authorization protocols, such as step therapy, contribute to delays in patient care. Step therapy can further prolong time to effective treatment, forcing patients to wait weeks or even months for medications or therapies their physicians have determined are appropriate,” said Sarah C. Nosal, MD, FAAFP, and President of American Academy of Family Physicians (AAFP), a Steering Committee member of the Safe Step Coalition. “The AAFP supports passage of the Safe Step Act to curb inappropriate use of step therapy by health plans and to establish a clear and timely process that helps patients access medically necessary care without unnecessary delays.”
“When a team at the University of Michigan diagnosed me with connective tissue overlap disease, including lupus, in 2016, I was hopeful that my symptoms would improve – but I quickly learned that a diagnosis didn’t automatically mean access to the right treatment,” said Keaka Stokes, a certified nursing assistant and Safe Step Coalition advocate from Michigan. “Patients like me have a right to live, and a right to answers – and those decisions should belong to us and our doctors, not our insurers.”
The Safe Step Act (H.R. 5509/S. 2903) would amend the Employee Retirement Income Security Act to require group health plans to establish a clear, transparent and standardized process for requesting an exception to a step therapy protocol. Plans would have to grant exceptions to step therapy in defined circumstances, including when a required treatment has already failed, when delay could cause serious harm, or when a patient is already stable on the prescribed medication. Plans would also have to answer standard requests within 72 hours, or 24 hours when a patient’s life is at risk. The Safe Step Act has been endorsed by 215 members of Congress across the House and Senate, more than 200 medical professional organizations and patient advocacy groups. To date, more than 30 states have enacted laws establishing a step therapy exception process, but those protections do not reach the roughly 100 million Americans in self-insured employer plans.
The Safe Step Act was introduced in the House by Representative Rick W. Allen, joined by original cosponsors Lucy McBath, Mariannette Miller-Meeks, Robert F. Onder, and Raul Ruiz, and in the Senate by Senator Lisa Murkowski, joined by original cosponsors Cory A. Booker, Ted Budd, Christopher A. Coons, Kevin Cramer, Catherine Cortez Masto, Margaret Wood Hassan, John W. Hickenlooper, Cindy Hyde-Smith, Tim Kaine, Roger Marshall, Jeff Merkley, Jerry Moran, Alex Padilla, Jacky Rosen, Jeanne Shaheen, Dan Sullivan, Raphael G. Warnock, and Ron Wyden.
Full poll results are available here. For questions or media inquiries, please contact Safe Step Coalition Co-Chairs Liz Siembida (lsiembida@psoriasis.org) or Hayley Dempsey (hdempsey@arthritis.org).
About the Safe Step Coalition
The Safe Step Coalition is an alliance of more than 225 patient and clinician advocacy organizations representing millions of Americans who are vulnerable to a harmful insurance practice known as step therapy, or “fail first.” Step therapy requires patients to try insurer-preferred medications and prove they fail before their health plan will cover the treatment their clinician prescribed. Together, the below organizations advocate for the passage of the Safe Step Act (H.R. 5509/S. 2903), bipartisan legislation that would establish a clear path to appeal step therapy requirements so patients can access the right treatment without unnecessary barriers.
