In March 2026, Indiana passed legislation to improve access to prescription drugs for patients with advanced or metastatic cancers. Indiana House Bill 1114 prohibits state employee health plans and related insurances from requiring these patients to try a lower cost medication before providing coverage for more expensive treatment options.
The Dangers of Step Therapy
Also known as a "try and fail” protocol, step therapy
puts control of cancer treatment in the hands of insurance companies, contradicts clinical guidance, and wastes valuable time.
Customized treatment plans based on a patient’s unique health goals and cancer prognosis don’t often align with step therapy requirements. According to data collected by the Cancer Care Community patient advocacy group, over 32 percent of patients reported starting treatment required by their insurer instead of taking medication originally prescribed to them, while 16 percent reported a delay in treatment while waiting for an exemption.
Since mortality increases for all cancer types when cancer is treated at a more advanced stage, early intervention is critical to successful treatment outcomes. Patients with metastatic cancers simply do not have time to fail treatments before finding one that works.
Addressing Step Therapy at the Federal Level
Step therapy has also garnered federal attention. Initially introduced in the House in 2023, the AACI-endorsed Safe Step Act
was reintroduced in 2025. The bill would require health plans to provide clear criteria for patients to request an exception to the protocol and would specify timelines under which insurers must respond to such requests.
With the mutual goal of shifting decision-making power to clinicians and patients, these state and federal efforts underscore the importance of timely treatment and patient autonomy.