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The comments, led by the Safe Step Coalition, highlight how prior authorization and step therapy requirements can interfere with timely access to medically necessary therapies.
The coalition called for reforms that would:
- Require standardized electronic prior authorization processes and reduce duplicative documentation.
- Automatically approve requests when insurers miss applicable review deadlines.
- Ensure denials are reviewed by clinicians with appropriate disease-specific expertise.
- Protect patients’ access to an established therapy while an appeal is pending or when they transition to a new health plan.
- Prevent prior authorization policies that are more restrictive than current clinical practice guidelines.
The comments also emphasize that step therapy requires separate safeguards. The coalition urged Congress to establish a uniform, transparent exceptions process, with decisions within 72 hours in standard cases and 24 hours in emergencies.
The coalition also called for continuity-of-care protections so patients are not required to repeat step therapy solely because they change plans, formularies, benefit categories, or sites of care.
NASPGHAN’s participation in the letter reinforces the need for health coverage policies that respect clinical judgment and preserve timely access to treatment for pediatric patients.
NASPGHAN members can get involved by encouraging lawmakers to cosponsor the Safe Step Act. Take action here.
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