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GHLF supports Iowa HF 233

4/ 11


AUTHOR: 50SN Staff

DATE: Apr 11, 2017


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GHLF supports Iowa HF 233

Global Healthy Living Foundation President and Co-Founder, Seth Ginsberg, issued a powerful statement to Iowa Governor Terry Branstad urging him to support House Bill 233.

Read the full statement below.

April 11, 2017

The Honorable Terry Branstad
Governor of Iowa State
Iowa State Capitol Building
Des Moines, Iowa, 50319

RE: HF 233 — Support

Dear Governor Branstad,

I am writing to you today on behalf of the more than 100,000 members nationwide of, a part of the Global Healthy Living Foundation, to express our support for House Bill 233, an act to amend the insurance law, in relation to the regulation of step therapy and first fail policies. Almost 1,000 members of CreakyJoints live in Iowa, and I write to you on behalf of those residents living with chronic pain.

CreakyJoints is an arthritis patient advocacy organization dedicated to building, sustaining and educating people with all forms of arthritis. Nearly 75 percent of our members have rheumatoid arthritis (RA), and I would like to specifically address their concerns regarding step therapy for the treatment of their RA and chronic pain.
About 1.3 million people in the United States are believed to have RA. Rheumatoid Arthritis is a painful condition that affects all ages, races, and social and ethnic groups. Although there is no cure for RA, the disease can be controlled in most people. Early, aggressive therapy to stop or slow inflammation in the joints can prevent or reduce painful symptoms, prevent or reduce joint destruction and deformity, and prevent or lessen disability and other complications.
Here are just a few examples explaining why step therapy strategies are problematic for RA patients and doctors:

  • Step therapy or fail first protocols require patients to experiment with various medications before getting the one originally prescribed by their doctor. Oftentimes patients have to “fail” up to five times before they are finally given the prescription that their doctor originally prescribed. The duration of this protocol is left up to the insurance company and can last up to 130 days per medication.
  • Step therapy is time-consuming from a physician and patient standpoint, is more expensive from a direct and indirect out-of-pocket cost perspective, it denies patients the drugs they need when they need them, and creates additional barriers leading people to forgo needed medications

Patients with rheumatoid arthritis need access to affordable prescription drugs coverage to manage their disease. HF 233 would bring Iowa one-step closer to changing practices that have resulted in higher long-term health care costs and the unnecessary physical and emotional suffering that patients endure with the changes below:

  • The patient and health care professional shall have access to a clear, readily accessible, and convenient process to request a step therapy override exception
  • The override exception process used shall be easily accessible on the internet site of the health carrier, health benefit plan, or utilization review organization.
  • By requiring a utilization organization to respond to a step therapy protocol override within five calendar days or seventy-two hours in the case of an emergency, HF 233 reduces the barriers between the patient and the medication originally described by their provider.
  • HF 233 ensures that decisions are made based on clinical review criteria rather than cost concerns by stating that a utilization review organization shall utilize recognized evidence-based and peer reviewed clinical review criteria that takes into account the needs of atypical patient populations and diagnoses.

In 2011 the Global Healthy Living Foundation launched a national campaign, “Fail First Hurts” (, to provide personal perspective on step therapy, or fail first practices by insurance companies. People living with pain associated with RA, and chronic or acute pain, need to efficiently and adequately address their needs through the medication intended by their physician. On behalf of the chronically ill members of our community living in Iowa, we request that you sign HF 233 into law. We stand ready and willing to support your efforts.

If you have questions or wish to discuss this further, please contact us 845-348-0400. We are happy to connect you with some of our patient advocates from Iowa that are eager to share their experiences undergoing step therapy policies.

Thank you for caring about patients and their need for quality access to care in Iowa.


Seth Ginsberg
President and Cofounder, Global Healthy Living Foundation

Click here to download a PDF of the letter