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by Amanda Conschafter, blog editor

Indiana Governor Mike Pence has signed into law a bill restricting the use of step therapy – following in the footsteps of California, Maryland, New Hampshire and other states that have tackled the issue. Step therapy, also known as “fail first,” occurs when insurers require patients to first try and fail on an inexpensive therapy before gaining access to the drug prescribed by their physician. The issue continues to plague physicians and patients across the country.

[WATCH: Understanding Step Therapy]

State Bill 41 limits step therapy by requiring insurers to create a process for patients and their physicians to request an exception to a step therapy protocol. As part of that process, state insurers must outline the timeframe and criteria for granting exceptions.

The new law may allow physicians to better control their patients’ treatment path. As dermatologist David Gerstein, MD, explained in a letter to the Indianapolis Star, “In my practice, I can significantly improve a patient’s condition…by prescribing the drug that best treats their condition and takes into account their medical history and existing symptoms. With step-therapy policies, my patients are forced to fail on other therapies, despite my medical recommendation, often delaying access to optimal treatment and causing unnecessary continued suffering.”

Though Indiana is the first state to pass legislation on step therapy this year, several other state legislatures have introduced similar bills. Among these are Kansas, Ohio, West Virginia and Illinois.

For more on step therapy and related legislation, visit

*Post updated May 12, 2016.

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