Gov. Branstad Signs HF 233 to Allow a More Transparent Overriding Process

Gov. Branstad (center) surrounded by patient organizations and advocates during Wednesday’s bill signing ceremony.

Middletown, CT, May 11, 2017 –  Through the efforts of advocates and patient organizations who formed the Iowa Fail First Coalition, of which U.S. Pain Foundation is a member, Iowa Gov. Terry Branstad has signed into law a bill which allows clinicians and patients a clear process to override the fail first protocol, also known as step therapy.

Currently, insurers in Iowa can force a patient to “fail first” on a series of less expensive and potentially inferior medications before receiving the therapy option originally prescribed by their clinician. By turning HF 233 into law, a health insurance carrier must now provide the prescribing health care professional and covered individual access to a clear, accessible and convenient process to request a step therapy override exception.

“By signing this much-needed bill into law, Gov. Branstad is sending the message to Iowa chronic pain patients that their lives matter and they deserve timely access to effective treatments to manage their condition,” said founder and president of U.S. Pain Foundation, Paul Gileno. “We believe every individual, whether a person living with chronic pain or another chronic condition, should have the opportunity to receive the treatment that the individual’s doctor feels is therapeutically necessary, without interference from insurance companies.”

The new law, effective Jan. 1, 2018, will not eliminate fail first/step therapy practices, but rather deters the harmful practice through the inclusion of safeguards surrounding an exceptions process. It will not prohibit a health carrier from requiring beneficiaries to try a generic version of medications, only completely different medications.

“We know that without protections, fail first/step therapy can lead to significant negative consequences for a person living with pain, or any Iowa resident on a prescription treatment to manage their health condition,” added Gileno. “We thank Gov. Branstad for turning into law a sound bill that encourages patient stability and improved health outcomes.”

Iowa now joins several other states who have approved patient protections against step therapy including New York, Connecticut, Illinois, Indiana, Kentucky and Missouri.

 About Step Therapy

Known as “fail first”, step therapy is an insurance practice which requires the least expensive drug in any class to be prescribed to a patient first, even if a patient’s physician believes a different therapy is medically in the best interest of their condition. Patients, including those with serious and degenerative medical conditions, can be forced to prove that cheaper and often less effective treatments have failed to adequately treat a patient’s condition for an indefinite period of time before the treatment initially prescribed by the physician is paid for by the insurance company.

U.S. Pain Foundation believes when step therapy stands in the way of treatments that are medically necessary, patients and their health care providers should have access to a clear and speedy process for seeking an exemption from an insurer’s step therapy protocol.

If you would like more information about this topic, please contact Shaina Smith at 860-315-7307 or email at

About U.S. Pain Foundation

The mission of U.S. Pain Foundation is to educate, connect, inform and empower those living with pain while also advocating on behalf of the entire pain community. As a 501 (c)3 nonprofit organization dedicated to serving those who live with pain conditions and their care providers, U.S. Pain Foundation helps individuals find resources and inspiration.