Although there are multiple types of drug access legislation being advanced in states across the country, the SAIM Coalition focuses on two primary policy areas: step therapy and out-of-pocket costs.
In efforts to control their own costs, many insurers are increasingly offering plans that rely on co-insurance in which beneficiaries must pay a percentage of their total costs rather than a fixed co-pay. Learn More.
Step therapy – or “fail first” policies – requires patients to use one or more insurer-selected medications without success before they can access the medication originally prescribed by their provider. Learn More.
Both practices can contribute to patients not getting the treatments they need when they need them which often results in worsened symptoms and associated higher healthcare costs. By helping to advance legislation in both of these areas, the SAIM Coalition aims to increase patients’ access to the drugs they need and to ensure that they are not overly burdened by the costs of these treatments.