A Republican bill with 113 Democratic cosponsors · See all 169 cosponsors
Last activity — Referred to the House Committee on Education and Workforce.
In committee
Introduced and handed to a committee in the chamber it started in.
The committee holds it, and most bills are never heard from again. A hearing or a committee vote would be news; silence is the usual outcome, and it kills the bill without anyone voting against it.
Its path through Congress
- Introduced
- In Committee
What this bill would do
The Safe Step Act seeks to amend the Employee Retirement Income Security Act of 1974. This bill requires group health plans or health insurance issuers that use medication step therapy protocols to provide a specific exceptions process. It mandates a clear, prompt, and transparent way for participants, beneficiaries, or their prescribers to request an exception to these protocols. The bill outlines specific circumstances that would qualify for an exception, such as ineffective previous treatments or risks of severe consequences. Additionally, it establishes strict timelines for how quickly insurance plans must respond to these requests.
Yes· 3 of 27
- Scored +7
Does this make health care easier to get in general?
Reduces barriers to necessary medications by streamlining the exception process for step therapy.
- Scored +6
Would people with disabilities be better off under this?
Directly addresses barriers to medications for people whose conditions make standard step therapy harmful or ineffective.
- Scored +5
Would people over 65 be better off under this?
High likelihood of benefit for seniors who often manage multiple comorbidities requiring specific non-preferred drugs.
The opposite
- Scored -2
Does this protect people from being watched or searched?
Requires the disclosure of private medical records to insurance companies to qualify for medication exceptions.
- Scored -2
Does this give people more control over their personal data?
May require patients to disclose sensitive medical history and records to insurance plans to obtain exceptions.
- Scored -1
Would business owners be better off under this?
May increase administrative costs for employers managing group health plans.
Who it would affect, and how
Potential Positive Impacts for People
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Access to Necessary Medication: Plans must cover requested drugs if certain criteria are met, such as when previous treatments were ineffective, a delay in treatment would cause severe consequences, or a drug is contraindicated due to potential harm (Section 2(a)(2) and Section 2(b)).
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Standardized and Transparent Processes: The bill requires a clear process that uses standard forms available in both paper and electronic formats, making it easier for people to navigate (Section 2(c)(1)).
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Protection of Physical and Mental Function: Exceptions can be requested if a required treatment prevents a person from achieving or maintaining reasonable and safe functional ability in occupational responsibilities or activities of daily living (Section 2(b)(4)).
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Stability for Chronic Conditions: People who are stable on a specific drug and have had prior coverage for it through a public or private plan can qualify for an exception (Section 2(b)(5)).
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Faster Decision Making: The bill mandates quick response times, requiring a determination within 72 hours for standard requests, or as little as 24 hours for expedited requests involving serious threats to life or health (Section 2(d)).
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Consistency in Coverage: Once an exception is granted, coverage for the requested drug must remain in effect for at least one year (Section 2(e)).
Potential Negative Impacts for People
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Information Disclosure Requirements: To qualify for an exception, participants or beneficiaries may be required to disclose their medical history or other health records to demonstrate that they have tried other drugs or established stability (Section 2(c)(1)(D)).
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Administrative Burden: While the bill aims for clarity, the process still requires the submission of specific criteria and documentation to the plan or issuer to determine if an exception is warranted (Section 2(c)(1)(D)).
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Tap or hover a score for the reason it gave.
- Demographic And Interest Groups
- Would people with disabilities be better off under this? — Directly addresses barriers to medications for people whose conditions make standard step therapy harmful or ineffective. Would people over 65 be better off under this? — High likelihood of benefit for seniors who often manage multiple comorbidities requiring specific non-preferred drugs. Would Black Americans be better off under this? — Improves access to critical medications for populations disproportionately affected by certain chronic diseases. Would Asian Americans be better off under this? — Improves access to critical medications for populations disproportionately affected by certain chronic diseases. Would children be better off under this? — Children with chronic conditions can access necessary medications faster through mandated exception processes. Would Hispanic Americans be better off under this? — Improves access to critical medications for populations disproportionately affected by certain chronic diseases. Would LGBTQ people be better off under this? — Facilitates access to gender-affirming or specialty medications if they are subject to step therapy. Would households on low incomes be better off under this? — Reduces the burden of navigating complex insurance hurdles to get necessary treatment. Would men be better off under this? — Improves access to specialty medications for chronic conditions. Would people in middle age be better off under this? — Reduces delays in treatment for adults dealing with chronic or severe illnesses. Would middle-income households be better off under this? — Improves outcomes for those with employer-sponsored group health plans. Would Native Americans be better off under this? — Improves access to critical medications for populations disproportionately affected by certain chronic diseases. Would union members be better off under this? — Beneficial for those in union-sponsored group health plans. Would white Americans be better off under this? — Improves access to critical medications for populations disproportionately affected by certain chronic diseases. Would women be better off under this? — Improves access to specialty medications often needed for autoimmune or endocrine conditions. Would people in their twenties and thirties be better off under this? — Provides better access to necessary medications through streamlined insurance exception processes. Would billionaires be better off under this? — General improvement in health insurance accessibility. Would high-income households be better off under this? — Provides more consistency in drug coverage across different plans. Would people with substantial wealth be better off under this? — General improvement in health insurance accessibility. Would the very wealthiest people be better off under this? — General improvement in health insurance accessibility. Would business owners be better off under this? — May increase administrative costs for employers managing group health plans.
- Healthcare
- Does this make health care easier to get in general? — Reduces barriers to necessary medications by streamlining the exception process for step therapy. Does this make mental health care easier to get? — Provides exceptions for medications treating mental health conditions if step therapy would cause harm or worsen the condition.
- Governance And Ideology
- Does this protect the right to fair treatment by the courts? — Establishes clear timelines and standard forms for the adjudication of medication exceptions. Does this make what the government does easier for the public to see? — Requires plans to report step therapy exception data to the Secretary and Congress, which is then made public. Does this give the federal government more power? — Increases federal oversight of group health plan administration via ERISA amendments. Does this protect people from being watched or searched? — Requires the disclosure of private medical records to insurance companies to qualify for medication exceptions.
- Economy And Finance
- Does this give people more protection from unfair business practices? — Enhances patient rights by providing a transparent process to challenge medication step therapy protocols.
- Social Issues And Justice
- Does this expand the rights of people with disabilities? — Helps individuals with chronic disabilities obtain specific medications more quickly when alternatives are ineffective.
- Education And Technology
- Does this give people more control over their personal data? — May require patients to disclose sensitive medical history and records to insurance plans to obtain exceptions.
- 10/5/2026
- 7 Cosponsors added.
- 9/14/2026
- 4 Cosponsors added.
- 9/1/2026
- 3 Cosponsors added.
- 7/22/2026
- 2 Cosponsors added.
- 7/14/2026
- 5 Cosponsors added.
- 6/30/2026
- 2 Cosponsors added.
- 6/24/2026
- 1 Cosponsor added.
- 6/23/2026
- 3 Cosponsors added.
- 6/11/2026
- 3 Cosponsors added.
- 6/4/2026
- 1 Cosponsor added.
- 5/21/2026
- 2 Cosponsors added.
- 5/13/2026
- 6 Cosponsors added.
- 4/29/2026
- 2 Cosponsors added.
- 4/28/2026
- 1 Cosponsor added.
- 4/27/2026
- 5 Cosponsors added.
- 4/15/2026
- 16 Cosponsors added.
- 3/26/2026
- 4 Cosponsors added.
- 3/25/2026
- 2 Cosponsors added.
- 3/18/2026
- 11 Cosponsors added.
- 3/4/2026
- 8 Cosponsors added.
- 2/24/2026
- 3 Cosponsors added.
- 2/20/2026
- 11 Cosponsors added.
- 2/12/2026
- 9 Cosponsors added.
- 2/10/2026
- 3 Cosponsors added.
- 2/4/2026
- 2 Cosponsors added.
- 1/22/2026
- 1 Cosponsor added.
- 1/20/2026
- 2 Cosponsors added.
- 1/14/2026
- 1 Cosponsor added.
- 1/13/2026
- 1 Cosponsor added.
- 1/7/2026
- 1 Cosponsor added.
- 12/16/2025
- 5 Cosponsors added.
- 12/12/2025
- 4 Cosponsors added.
- 12/10/2025
- 2 Cosponsors added.
- 12/9/2025
- 1 Cosponsor added.
- 11/21/2025
- 1 Cosponsor added.
- 11/20/2025
- 1 Cosponsor added.
- 11/17/2025
- 3 Cosponsors added.
- 11/7/2025
- 26 Cosponsors added.
- 9/19/2025
- Referred to the House Committee on Education and Workforce.
- 4 Cosponsors added.
- Introduced in House
One bill Congress.gov lists as related to this one — companions in the other chamber, earlier versions, and bills this one absorbed or was folded into.
Alma AdamsDemocrat · North Carolina
Gabe AmoDemocrat · Rhode Island
Sanford BishopDemocrat · Georgia
Suzanne BonamiciDemocrat · Oregon
Joyce BeattyDemocrat · Ohio
Ami BeraDemocrat · California
Donald BeyerDemocrat · Virginia
Troy BaldersonRepublican · Ohio
Nikki BudzinskiDemocrat · Illinois
Becca BalintDemocrat · Vermont
Janelle BynumDemocrat · Oregon
Ed CaseDemocrat · Hawaii
Emanuel CleaverDemocrat · Missouri
Kathy CastorDemocrat · Florida
Yvette ClarkeDemocrat · New York
Steve CohenDemocrat · Tennessee
Joaquin CastroDemocrat · Texas
Earl CarterRepublican · Georgia
J. CorreaDemocrat · California
Salud CarbajalDemocrat · California
Angie CraigDemocrat · Minnesota
Jason CrowDemocrat · Colorado
Mike CareyRepublican · Ohio
Sheila Cherfilus-McCormickDemocrat · Florida
Herbert ConawayDemocrat · New Jersey
Jeff CrankRepublican · Colorado
Donald DavisDemocrat · North Carolina
Christopher DeluzioDemocrat · Pennsylvania
Suzan DelBeneDemocrat · Washington
Debbie DingellDemocrat · Michigan
Neal DunnRepublican · Florida
Sharice DavidsDemocrat · Kansas
Madeleine DeanDemocrat · Pennsylvania
Mike EzellRepublican · Mississippi
Adriano EspaillatDemocrat · New York
Brian FitzpatrickRepublican · Pennsylvania
Lizzie FletcherDemocrat · Texas
Mike FloodRepublican · Nebraska
Maxwell FrostDemocrat · Florida
Valerie FousheeDemocrat · North Carolina
Shomari FiguresDemocrat · Alabama
Laura FriedmanDemocrat · California
Randy FineRepublican · Florida
Sam GravesRepublican · Missouri
Al GreenDemocrat · Texas
Vicente GonzalezDemocrat · Texas
Josh GottheimerDemocrat · New Jersey
Michael GuestRepublican · Mississippi
Daniel GoldmanDemocrat · New York
Marie PerezDemocrat · Washington
Laura GillenDemocrat · New York
Maggie GoodlanderDemocrat · New Hampshire
Adelita GrijalvaDemocrat · Arizona
James HimesDemocrat · Connecticut
Andy HarrisRepublican · Maryland
Bill HuizengaRepublican · Michigan
Richard HudsonRepublican · North Carolina
J. HillRepublican · Arkansas
Jahana HayesDemocrat · Connecticut
Chrissy HoulahanDemocrat · Pennsylvania
Diana HarshbargerRepublican · Tennessee
Ashley HinsonRepublican · Iowa
Erin HouchinRepublican · Indiana
Pat HarriganRepublican · North Carolina
Henry JohnsonDemocrat · Georgia
John JoyceRepublican · Pennsylvania
Julie JohnsonDemocrat · Texas
William KeatingDemocrat · Massachusetts
Mike KellyRepublican · Pennsylvania
Raja KrishnamoorthiDemocrat · Illinois
Young KimRepublican · California
Thomas KeanRepublican · New Jersey
Jennifer KiggansRepublican · Virginia
Timothy KennedyDemocrat · New York
Mike KennedyRepublican · Utah
Stephen LynchDemocrat · Massachusetts
Ted LieuDemocrat · California
Barry LoudermilkRepublican · Georgia
Darin LaHoodRepublican · Illinois
Mike LevinDemocrat · California
Anna Paulina LunaRepublican · Florida
Nick LaLotaRepublican · New York
Michael LawlerRepublican · New York
Nicholas LangworthyRepublican · New York
Summer LeeDemocrat · Pennsylvania
Nancy MaceRepublican · South Carolina
James McGovernDemocrat · Massachusetts
Tracey MannRepublican · Kansas
Gregory MeeksDemocrat · New York
Betty McCollumDemocrat · Minnesota
Gwen MooreDemocrat · Wisconsin
Doris MatsuiDemocrat · California
Grace MengDemocrat · New York
Seth MoultonDemocrat · Massachusetts
Brian MastRepublican · Florida
Carol MillerRepublican · West Virginia
Lucy McBathDemocrat · Georgia
Gregory MurphyRepublican · North Carolina
Frank MrvanDemocrat · Indiana
Mariannette Miller-MeeksRepublican · Iowa
Kevin MullinDemocrat · California
Jennifer McClellanDemocrat · Virginia
Ryan MackenzieRepublican · Pennsylvania
April McClain DelaneyDemocrat · Maryland
Kelly MorrisonDemocrat · Minnesota
Tim MooreRepublican · North Carolina
Sarah McBrideDemocrat · Delaware
John McGuireRepublican · Virginia
Analilia MejiaDemocrat · New Jersey
Jerrold NadlerDemocrat · New York
Eleanor NortonDemocrat · District of Columbia
Donald NorcrossDemocrat · New Jersey
Dan NewhouseRepublican · Washington
Burgess OwensRepublican · Utah
Alexandria Ocasio-CortezDemocrat · New York
Ilhan OmarDemocrat · Minnesota
Robert OnderRepublican · Missouri
Chellie PingreeDemocrat · Maine
Mark PocanDemocrat · Wisconsin
Scott PetersDemocrat · California
Jimmy PanettaDemocrat · California
Chris PappasDemocrat · New Hampshire
Deborah RossDemocrat · North Carolina
Patrick RyanDemocrat · New York
Raul RuizDemocrat · California
David RouzerRepublican · North Carolina
Jamie RaskinDemocrat · Maryland
John RutherfordRepublican · Florida
Emily RandallDemocrat · Washington
Josh RileyDemocrat · New York
Maria SalazarRepublican · Florida
Brad ShermanDemocrat · California
Adam SmithDemocrat · Washington
Linda SánchezDemocrat · California
Marilyn StricklandDemocrat · Washington
Bradley SchneiderDemocrat · Illinois
Darren SotoDemocrat · Florida
Thomas SuozziDemocrat · New York
Mary Gay ScanlonDemocrat · Pennsylvania
Greg StantonDemocrat · Arizona
W. SteubeRepublican · Florida
Haley StevensDemocrat · Michigan
Kim SchrierDemocrat · Washington
Melanie StansburyDemocrat · New Mexico
Hillary ScholtenDemocrat · Michigan
Emilia SykesDemocrat · Ohio
Eric SorensenDemocrat · Illinois
Derek SchmidtRepublican · Kansas
Jefferson ShreveRepublican · Indiana
Lateefah SimonDemocrat · California
Michael TurnerRepublican · Ohio
Glenn ThompsonRepublican · Pennsylvania
Paul TonkoDemocrat · New York
Rashida TlaibDemocrat · Michigan
Lori TrahanDemocrat · Massachusetts
Ritchie TorresDemocrat · New York
Jill TokudaDemocrat · Hawaii
Shri ThanedarDemocrat · Michigan
Juan VargasDemocrat · California
Beth Van DuyneRepublican · Texas
Derrick Van OrdenRepublican · Wisconsin
Gabe VasquezDemocrat · New Mexico
Eugene VindmanDemocrat · Virginia
Nikema WilliamsDemocrat · Georgia
Joe WilsonRepublican · South Carolina
Debbie Wasserman SchultzDemocrat · Florida
Robert WittmanRepublican · Virginia
James WalkinshawDemocrat · Virginia
Rudy YakymRepublican · Indiana