Another step therapy win! How to make it happen in your state

This month, Iowa passed step therapy legislation, joining 13 other states offering step therapy protection to patients. In 2017, legislation also is being considered in at least 12 other states. Carole McClanahan, MD, MPH, a second-year resident at the University of Iowa, discusses her involvement in the passage of the step therapy law in Iowa and how members can get involved in their states.

Member to Member: How did you get involved in step therapy advocacy in Iowa?

AAEAAQAAAAAAAAIwAAAAJDIzOGVjZjM0LTAyOTYtNDRlYS1hZTMyLTJjMjYzNGJhNzYxNg.jpgDr. McClanahan: My involvement started with the Academy’s Legislative Conference last fall. I attended a session on state level issues where step therapy was discussed. I immediately saw that this is something that impacts my patients on a daily basis.

I started looking into what legislation Iowa had related to step therapy. I discovered that Iowa had not passed a step therapy law. I started investigating whether there was a push for legislation, and I discovered that the National Psoriasis Foundation and the Arthritis Foundation, along with the Academy, had started efforts to get a step therapy law passed in Iowa. I felt strongly about the issue, so I decided to get involved in these efforts.


M2M: What role did you play in advocating for a step therapy law?

Dr. McClanahan: I participated in several ways. I testified at a subcommittee hearing. I also visited the Capitol on two different occasions to lobby elected officials. I had one-on-one meetings with several influential officials. I also reached out to legislators via email and phone. In addition, I discussed the issue with the Iowa Dermatologic Society and the University of Iowa Department of Dermatology, and I sent templated emails to these groups so that people could forward letters of support to their legislators.

M2M: How did legislators respond to your efforts?

Dr. McClanahan: I received surprisingly good responses. I had many senators and representatives tell me that it was good to hear a doctor’s perspective and to hear how step therapy guidelines were impacting our patients. It seemed really important for legislators to hear our perspective on the issue.

M2M: Were you surprised that the law passed?

Dr. McClanahan: Yes, a little bit. We were fighting a powerful lobbying effort from insurance companies that didn’t want the law passed. They were spreading misinformation, telling legislators that a law would increase regulation, and that the law would tell insurance companies what they would and wouldn’t have to cover. I was worried that the misinformation campaign would lead to the legislation not passing. But, ultimately, it passed.

M2M: How will the new step therapy law change health care in Iowa?

Dr. McClanahan: It’s a big win for our patients. I see how step therapy guidelines negatively impact patients on a daily basis. For example, I’ll have a patient who is really well controlled on ustekinumab. And then the patient will switch insurance companies. All of a sudden the new insurance company says: “We know you’ve already tried methotrexate and acitretin, but you didn’t try them under our plans. Even though they failed for you before, we’re going to make you try them again before we’ll cover the medication you’re currently on that’s working.”

Then, not surprisingly, those patients start to relapse. After several months of disease flares, they’re able to get back on the medication that worked for them to begin with. Step therapy legislation will help prevent patients from trying and failing medications that they’ve already tried and failed. The new law will help expedite treatments that are appropriate for their conditions.

M2M: Do you have any advice for Academy members interested in step therapy legislation in their own states?

Dr. McClanahan: We as physicians have a unique background and expertise when we advocate for health care issues. Because we see how this issue impacts our patients daily, we are able to advocate for it with first-hand stories that strike an emotional cord with legislators. It puts a human face on the issue. It’s very powerful to advocate personally, and I encourage physicians to get involved in this issue.

To get started, contact the Academy. The Academy was key in helping get step therapy laws passed in several states and is currently working to pass laws in several more. They’ll work with you and your state society to help organize your advocacy issues.

I also recommend attending the Academy’s Legislative Conference. I attended in 2016 and it was a wonderful and eye-opening opportunity that taught me practical skills about how to get involved at a grassroots level. I recommend the event to members with any level of political expertise.


Submit your step therapy story

Have you experienced step therapy and has it delayed you from accessing a necessary treatment? If so, then the AAD wants to hear from you. The AAD state policy team is active all year long in advocating for states to enact step therapy laws. Fill out the form below and encourage your patients to do so, as well.

Your name
Home state
Are your a healthcare provider or a patient?
Email or phone
Drug you lost access to and/or would like to gain access to
Experience with drug coverage changes, Prior Authorization and/or step therapy
Note: If you would like information on the step therapy law in your respective state please contact the AADA state policy team at and