S2903119th CongressWALLET

Safe Step Act

Sponsored By: Senator Lisa Murkowski

Introduced

Summary

Creates a mandatory, transparent exceptions process for medication step therapy so patients and prescribers can quickly request coverage of a non-preferred drug when medically needed. The bill sets timelines, standard forms, and public notice rules to make exception requests faster and clearer.

Show full summary
  • Patients and prescribers would get a clear path to request exceptions, submit clinical rationale on a standard paper or electronic form, and designate a third-party advocate. Plans must respond within 72 hours for routine requests and within 24 hours for emergencies, and granted exceptions must remain covered for at least one year.
  • Group health plans and insurers would have to publish the process, forms, required supporting information, and contact details on plan materials and websites. The bill limits information requests to what is strictly necessary and stops pharmacy benefit managers or third-party administrators from withholding data needed for reporting.
  • Plans would report counts and outcomes of exception requests by circumstance, specialty, and condition starting not later than three years after enactment and each year thereafter by October 1. The Secretary of Labor would compile a Congressional summary of trends, and the Secretary must issue final implementing regulations within six months with the rule applying to plan years that begin at least six months after enactment.

Bill Overview

Analyzed Economic Effects

6 provisions identified: 6 benefits, 0 costs, 0 mixed.

Clear drug exception process

This bill would require employer group health plans that use step therapy to have a clear, quick exception process. You, your doctor, or a chosen representative could request an exception using a standard form. Plans would have to publish the form, instructions, and contact information in plan materials and on plan websites.

Faster decisions for drug exceptions

This bill would require plans to answer routine exception requests within 72 hours. If a plan asks for more needed information, it must decide within 72 hours after getting it. For urgent cases that could risk life, health, major function, or severe pain, plans would have 24 hours to decide.

Guaranteed coverage after an exception

If a plan grants an exception, this bill would require the plan to cover the drug under the plan's cost-sharing terms in effect at the plan year's start. Coverage under the exception would have to last at least one year for that person.

When exceptions must be approved

This bill would list six reasons a plan must approve a step-therapy exception. Examples include when required drugs already failed, are contraindicated, would seriously harm health or function, or when a patient is stable on the prescribed drug. The Secretary could add other reasons.

Annual reports on step-therapy requests

This bill would make group plans report counts of exception requests and outcomes to the Secretary. The first report would be due within three years of enactment, then every year by October 1. Plans could not sign contracts that block the data needed for these reports.

Labor must write final rules

This bill would require the Labor Department to issue final rules to implement the exceptions process within six months of enactment. The rules would go through public notice-and-comment rulemaking to guide plans and issuers.

Sponsors & CoSponsors

Sponsor

Lisa Murkowski

AK • R

Cosponsors

  • Maggie Hassan

    NH • D

    Sponsored 9/18/2025

  • Roger Marshall

    KS • R

    Sponsored 9/18/2025

  • Jacky Rosen

    NV • D

    Sponsored 9/18/2025

  • Alex Padilla

    CA • D

    Sponsored 9/18/2025

  • John Hickenlooper

    CO • D

    Sponsored 9/18/2025

  • Jeff Merkley

    OR • D

    Sponsored 9/18/2025

  • Dan Sullivan

    AK • R

    Sponsored 9/18/2025

  • Raphael Warnock

    GA • D

    Sponsored 9/18/2025

  • Cindy Hyde-Smith

    MS • R

    Sponsored 9/18/2025

  • Catherine Cortez Masto

    NV • D

    Sponsored 9/18/2025

  • Jerry Moran

    KS • R

    Sponsored 9/18/2025

  • Kevin Cramer

    ND • R

    Sponsored 9/18/2025

  • Timothy Kaine

    VA • D

    Sponsored 9/18/2025

  • Ted Budd

    NC • R

    Sponsored 9/18/2025

  • Jeanne Shaheen

    NH • D

    Sponsored 9/18/2025

  • Cory Booker

    NJ • D

    Sponsored 9/18/2025

  • Ron Wyden

    OR • D

    Sponsored 9/18/2025

  • Christopher Coons

    DE • D

    Sponsored 9/18/2025

  • Richard Blumenthal

    CT • D

    Sponsored 10/1/2025

  • John Boozman

    AR • R

    Sponsored 10/1/2025

  • Kirsten Gillibrand

    NY • D

    Sponsored 10/1/2025

  • Thomas Tillis

    NC • R

    Sponsored 10/7/2025

  • Martin Heinrich

    NM • D

    Sponsored 10/7/2025

  • Amy Klobuchar

    MN • D

    Sponsored 10/7/2025

  • Chris Van Hollen

    MD • D

    Sponsored 10/21/2025

  • Adam Schiff

    CA • D

    Sponsored 10/23/2025

  • Mark Kelly

    AZ • D

    Sponsored 10/23/2025

  • Deb Fischer

    NE • R

    Sponsored 10/27/2025

  • Gary Peters

    MI • D

    Sponsored 11/19/2025

  • Tammy Duckworth

    IL • D

    Sponsored 12/4/2025

  • Jon Ossoff

    GA • D

    Sponsored 12/9/2025

  • Tina Smith

    MN • D

    Sponsored 12/16/2025

  • Susan Collins

    ME • R

    Sponsored 2/12/2026

Roll Call Votes

No roll call votes available for this bill.

View on Congress.gov

Related Bills

Back to Legislation

Take It Personal

Get Your Personalized Policy View

Create a free account to save research, track policy impacts, and unlock your personalized versions of these pages.

Already have an account? Sign in