National polling: Fail first policies harm patients by delaying access to medications

A recent national poll from the PAN Foundation finds that most adults (55 percent) who have been required to ‘fail first’ say the policy delayed their access to the medication their healthcare provider originally prescribed by up to 11 weeks. Fail first policies, also known as step therapy, are health insurance policies that require patients to try and fail an insurer-preferred medication before covering the medication that was originally prescribed.

Key findings include:  

• 1 in 6 (16 percent) adults say their health insurance provider has required them to ‘fail first’ before authorizing medication prescribed by their healthcare provider.  
• The majority (59 percent) of adults who have been required to ‘fail first’ say they appealed their health insurance provider’s request.  
• 1 in 5 adults who were required to ‘fail first’ say they had to visit the emergency room (21 percent) or be admitted to the hospital (20 percent) as a result of the policy.  

“When patients are prescribed a medication by their provider, they shouldn’t have to wait weeks or months to access that medication,” said Amy Niles, Chief Advocacy and Engagement Officer at the PAN Foundation. “These polling results reinforce the fact that step therapy harms patients by delaying care. That’s why the PAN Foundation is calling on Congress to take action to curb restrictive utilization management practices and put patients first.” 
 
In addition to delaying care, step therapy can also lead to severe side effects and irreversible disease progression for some patients. While a bipartisan group of lawmakers introduced the Safe Step Act (S. 652/H.R. 2630) in 2023, the bill was never brought to a vote. The Safe Step Act would amend the Employee Retirement Income Security Act (ERISA) to require a group health plan provide an exception process for any medication step therapy protocol. The PAN Foundation will continue to join other patient advocacy organizations in advocating for federal legislation that makes it easier for patients to access the healthcare they need and deserve.

Additional resources: 

• Curb restrictive utilization management practices – PAN Foundation 
• PAN joins 200+ organizations in support of Safe Step Act 

Polling methodology: This poll was conducted by Morning Consult on behalf of the PAN Foundation between December 2-4, 2023, among a sample of 2,202 adults. The interviews were conducted online and the data were weighted to approximate a target sample of adults based on age, gender, race, educational attainment, region, gender by age, and race by educational attainment. Results from the full survey have a margin of error of plus or minus 2 percentage points. 

About the PAN Foundation   

The PAN Foundation is an independent, national 501 (c)(3) organization dedicated to helping federally and commercially insured people living with life-threatening, chronic, and rare diseases with the out-of-pocket costs for their prescribed medications.   

Since 2004, we have provided more than 1.1 million underinsured patients with $4 billion in financial assistance. Partnering with generous donors, healthcare providers and pharmacies, we provide the underinsured population access to the healthcare treatments they need to best manage their conditions and focus on improving their quality of life. Learn more at panfoundation.org.