Advocacy in Texas

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State Fact Sheet 
Find out how arthritis affects people in Texas 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 Texas 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 Texas?  

In 2017, Texas 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.  The bill includes essential patient protections to improve the safety and efficiency of step therapy protocols.  This includes a requirement that insurers must consider using science and evidence-based clinical practice guidelines to develop step therapy protocols, rather than relying exclusively on cost data.  The bill also requires a clear and expedient process that can be used by treating physicians to request an override of a step therapy protocol.  Prohibits insurers from requiring patients to fail on a prescribed medication more than once, even if patient switches to a different health insurance company.    

Which patients will benefit from this new law?  

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 Texas?  

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. 

• Learn more about how the law affects Texans by watching this short video
• View or download the video slides
• View and print our easy to use handout explaining the impact of the new law