An Interview with ACR Honoree Rep. Raul Ruiz on Step Therapy Reform

At the ACR’s Advocates for Arthritis conference in Washington, D.C., in September, Rep. Raul Ruiz, MD (D-Calif.), received the organization’s 2019 Award for Public Leadership in Rheumatology in recognition of his outstanding work on step therapy reform and other issues in support of rheumatology care.

“I was honored to receive the ACR Executive Committee Award and meet with the executive committee,” Rep. Ruiz tweeted from the event. “I look forward to continuing our shared work to empower patients in California and across the country!”

Last April, Representatives Ruiz and Brad Wenstrup, DPM (R-Ohio), introduced the Safe Step Act (H.R. 2279) in the House of Representatives. The bipartisan legislation, which amends the Employee Retirement Income Security Act of 1974, would limit the use of step therapy and offer a path for patients and physicians to seek reasonable exceptions. A similar bill, the Safe Step Act of 2019 (S. 2546) was introduced last month in the Senate.

ACR President Paula Marchetta presents Rep. Raul Ruiz with the 2019 Award for Public Leadership in Rheumatology on Sept. 12, 2019.

“Congressman Ruiz has been a champion for rheumatology issues and the entire physician community. As a physician in Congress, he understands the needs of our members and patients, as reflected in his spearheading step therapy reform, fighting for better recognition of the expert cognitive care our members provide, protecting access to Medicare for seniors and his leading bipartisan efforts to address the many other healthcare issues facing our nation,” says ACR president Paula Marchetta, MD, MBA. “We were proud to recognize and thank him for his leadership by presenting him with this prestigious award.”

Treatment Barriers
Although similar legislation has been passed in 25 states, Congressional action is still needed because employer-provided plans are regulated by federal law.

Step therapy, sometimes called “fail first,” is touted by insurance companies as a cost-control measure to reduce expenses related to specific drugs, treatments or tests. Insurance carriers require patients to try one or more medications that they prefer due to their negotiated formularies; only if the initial drug fails to work for the patient will the carrier approve coverage for the drug the treating physician selected for that patient, even if the physician is certain the insurer-preferred treatment will not be effective. This process can cause long treatment delays and place patients’ health in serious jeopardy.

Evidence of Harm
As one of 17 physician members of Congress, Rep. Ruiz, an emergency medicine physician, has advocated reforming step therapy while educating members of Congress about the practice’s negative impact on patient care.