… we have a small favor to ask. Thousands of people have placed their trust in the Racine County Eye’s high-impact journalism because we focus on solutions-based journalism.

With no shareholders or billionaire owners, we can provide trustworthy journalism that focuses on helping readers.

Unlike many others, Racine County Eye’s journalism is available for everyone to read, regardless of what they can afford to pay. We do this because we believe in information equality. Greater numbers of people can keep track of events, understand their impact on people and communities, and become inspired to take meaningful action.

If there were ever a time to join us, it is now. Every contribution, however big or small, powers our journalism and sustains our future. Support the Racine County Eye from as little as $5 – it only takes a minute. Thank you.

$
$
$

Your contribution is appreciated.

MADISON, WI — A new law aimed at helping Wisconsin patients navigate insurance-mandated Step Therapy procedures will go into effect this November.

Step therapy, also known Fail First, is an insurance policy protocol that requires the cheapest drug to be prescribed to a patient first, rather than the medicine the doctor originally prescribed.

Wisconsin’s new step therapy law establishes a new set of requirements that health insurance companies have to follow when requiring a patient to try a different and less expensive treatment option than the one prescribed by the patient’s doctor via a Step Therapy process.

The Step Therapy Law requires that all insurers, pharmacy managers or benefit review boards that have a step therapy protocol for prescription medications must meet certain requirements, including:

  • The protocol must be based upon clinical review criteria
  • The process and criteria for selecting and evaluating clinical practice guidelines used to develop the protocol must be posted to the entity’s website
  • The process to request an exception must be clear, accessible, and convenient
  • An appeal process must be established for insureds whose request for an exception is denied.

Gov. Tony Evers signed the Step Therapy bill into law in July 2019. While the Step Therapy Law goes into effect on Nov. 1, plans using a step therapy protocol have until Jan. 1, 2020, to ensure that they comply.

The Office of the Commissioner of Insurance (OCI) issued a bulletin to insurers and interested parties on October 16 summarizing the new law.

Step Therapy Has Its Critics

According to the advocacy website Fail First Hurts, “When a patient has to fail first on a drug before being allowed to take the medication originally prescribed, the patient, physician and public health suffer. By limiting the medication options, both doctors and patients are forced to compromise their treatment decisions in a way that is dangerous, time consuming and more expensive in the long-term.”

The Illinois State Medical Society reportedly fought for reforms in 2018 to make sure there was a step therapy exception review. “ISMS continues to advocate for insurance reforms that put patients first and reduce administrative hassles for physicians,” they wrote in March 2018.

And in Oklahoma, lawmakers pushed for step therapy reform, citing the need to help people get the medications they need in a timely fashion. Under a bill brought forward earlier this year, establishes limits on step therapy including adding procedures to determine medical exemptions.


Racine County Eye and Patch are partnering up to provide readers with more local content and provide local advertisers with a larger audience to connect with.

Based in New York, Patch is a hyperlocal platform that currently serves over 1,200 communities, towns and cities across the U.S. Known as “The Patch” by its users, Patch is the go-to destination for hyperlocal news and discussion about your community. 

Advertising disclosure
To support our site and content, we work with partners to present valuable offers to help you save, earn, and get ahead. We may be compensated for the purchase of goods and services made through the links in this offer program.
Offers for you
Curated offers for our readers
advertiser disclosure
CodeMonkey
Coding for kids! Introducing programming games for the next generation. Get your kids coding today.
Start with a free trial.
Start with a free trial.

Get your students coding in no time!

CodeMonkey is a fun and educational game-based environment where kids learn to code without any prior experience. After completing CodeMonkey's award-winning coding courses, kids will be able to navigate through the programming world with a sense of confidence and accomplishment.

Kids will love learning to code with CodeMonkey

  • Ready to Go Courses. With CodeMonkey’s teacher kit and support team, anyone can teach the basics of computer science.
  • Real Coding Languages. CodeMonkey's courses teach text-based coding so students learn to program like a real developer.
  • Game-Based Learning. Kids learn coding in an engaging and rewarding environment that utilizes gaming elements.

Free Trial - Enjoy a full-blown gaming experience that will teach your kids to code!