About Our Model Legislation

The SAIM Coalition advocates for the passage of laws to reform the use of step therapy and to reduce the burden of out-of-pocket (OOP) costs for medications. The Coalition has developed model bill language to try to ensure consistency in such laws across the country. Included in this section is model language for step therapy and OOP costs legislation.

Step Therapy Legislation

The SAIM Coalition supports common-sense limits on step therapy. Our model legislation focuses on creating clear exceptions to step therapy protocols, establishing clear timelines for insurer responses to requests for exceptions, and ensuring that patients who are successfully using a treatment do not have to switch.

Click here to view the Coalition’s model language.

Out of Pocket Costs Model Legislation

The SAIM Coalition works to limit the burden of out-of-pocket costs. Our model legislation focuses on requiring insurers to offer copay only cost-sharing insurance products in which the copays are proportionate to formulary tiers, limiting annual OOP costs for prescription drugs, and prohibiting discriminatory plan benefit design and marketing and enrollment practices.

Click here to view the Coalition’s model language.