Advocacy in Iowa

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State Fact Sheet 
Find out how arthritis affects people in Iowa and what you can do to make a difference. 

State of Your Health 
If you are experiencing a barrier to care, you should contact your insurance commissioner, who can help address your situation. Please be sure to view our Iowa Department of Insurance fact sheet that gives instructions on how to appeal, request an external review or file a complaint with your insurance commissioner.

What is step therapy?   

Step therapy is a practice used by insurers that requires people with arthritis to try lower-cost medications before permitting more expensive treatments, even when the doctor wants to prescribe them. In other words, more expensive and effective drugs can only be prescribed if the cheaper ones prove ineffective.  

How does this new law address step therapy in Iowa?  

In 2017, Iowa passed legislation to address step therapy and the law went into effect in early 2018.  This new law increases the ability of the patient’s health care provider, not insurance company, to make important decisions about a patient’s treatment.  If an insurer denies a request (within 5 days or 72 hours in an emergency), they must provide a reason.  Medical exceptions shall be approved if required prescription drug is contraindicated, is expected to be ineffective based on known clinical characteristics of the patient, patients documented experience with the prescription drug regimen; if patient is experiencing positive therapeutic outcome on another prescription drug selected by their HCP under current or previous health plan. 

Which patients will benefit from this new law?  

Patients with individual or fully insured group health insurance coverage will benefit from these new protections against burdensome step therapy protocols.  The new law does not apply to Medicare, Medicaid fee-for service or "self-insured" plans, which are exempted by the federal Employee Retirement Income Security Act of 1974 (ERISA).  To learn if you are covered, contact your insurer and provide your policy number.    

What should I do if I experience this barrier to care in Iowa?  

If you are experiencing a barrier to care, you should contact your insurance commissioner, who can help address your situation. You can easily find instructions on how to appeal, request an external review, or file a complaint to your Insurance Commissioner with our Department of Insurance one pager, click here to learn more.