{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:18:07Z","timestamp":1787019487119,"version":"build-2736575974"},"reference-count":35,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2024,5,7]],"date-time":"2024-05-07T00:00:00Z","timestamp":1715040000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Psoriasis and Psoriatic Arthritis"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:p>Pharmaceutical expenditures in the United States, particularly in dermatology, have grown rapidly, driven by expensive topical and biologic treatments. Insurers are employing cost-containing strategies such as step therapy, which mandates the use of lower-cost treatments before more expensive medications. The bipartisan Safe Step Act aims to enhance step therapy policies by introducing a transparent process for requesting exceptions and reasonable timelines for the process. However, there is limited analysis on how the Safe Step Act would affect the healthcare environment. We examine the policies of the Safe Step Act and existing literature on prior authorizations and discuss how the bill could affect patients, physicians, and insurers. While the act could expedite access to necessary medications and prevent irreversible harm to patients from delaying efficacious treatment, it falls short in relieving the administrative burdens on dermatology clinics. Although there is no ideal solution for managing healthcare costs, measures like step therapy encourage cost-effective treatments and optimizing care for the population. Curtailing step therapy with the exemptions process of the Safe Step Act might streamline patient access to treatments but could impede cost-containment strategies, weaken the bargaining power of insurers, and result in higher insurance premiums.<\/jats:p>","DOI":"10.1177\/24755303241253203","type":"journal-article","created":{"date-parts":[[2024,5,7]],"date-time":"2024-05-07T23:48:11Z","timestamp":1715125691000},"page":"115-120","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Analyzing the Benefits and Costs of the Safe Step Act on Patients, Physicians, and Insurers"],"prefix":"10.1177","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-1957-6622","authenticated-orcid":false,"given":"Divya M.","family":"Shan","sequence":"first","affiliation":[{"name":"Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan D.","family":"Greenzaid","sequence":"additional","affiliation":[{"name":"Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estay","family":"Greene","sequence":"additional","affiliation":[{"name":"Amwins Rx, North Kingstown, RI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0090-6289","authenticated-orcid":false,"given":"Steven R.","family":"Feldman","sequence":"additional","affiliation":[{"name":"Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA"},{"name":"Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA"},{"name":"Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston Salem, NC, USA"},{"name":"Department of Dermatology, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,5,7]]},"reference":[{"key":"bibr1-24755303241253203","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2015.3897"},{"key":"bibr2-24755303241253203","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.o693"},{"key":"bibr3-24755303241253203","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2021.00822"},{"key":"bibr4-24755303241253203","doi-asserted-by":"publisher","DOI":"10.5070\/D3264048341"},{"key":"bibr5-24755303241253203","unstructured":"Murkowski L. Safe step act. https:\/\/www.congress.gov\/bill\/118th-congress\/senate-bill\/652\/text"},{"key":"bibr6-24755303241253203","unstructured":"Wenstrup B. Safe step act. https:\/\/www.congress.gov\/bill\/118th-congress\/house-bill\/2630\/text?s=1&r=9"},{"key":"bibr7-24755303241253203","doi-asserted-by":"publisher","DOI":"10.1017\/S1744133121000153"},{"key":"bibr8-24755303241253203","unstructured":"Step Therapy Legislation By State. Step therapy legislation by state. https:\/\/steptherapy.com\/step-therapy-legislation-by-state\/. Accessed April 2, 2024."},{"key":"bibr9-24755303241253203","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2020.1852"},{"key":"bibr10-24755303241253203","unstructured":"American Medical Association. AMA prior authorization (PA) physician survey. 2022. https:\/\/www.ama-assn.org\/system\/files\/prior-authorization-survey.pdf. Accessed April 2, 2024."},{"issue":"3","key":"bibr11-24755303241253203","first-page":"247","volume":"17","author":"Papp KA","year":"2018","journal-title":"J Drugs Dermatol JDD"},{"key":"bibr12-24755303241253203","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2018.11.057"},{"key":"bibr13-24755303241253203","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2007.08315.x"},{"issue":"6","key":"bibr14-24755303241253203","first-page":"32","volume":"3","author":"Hagland M","year":"2006","journal-title":"Biotechnol Healthc"},{"key":"bibr15-24755303241253203","doi-asserted-by":"publisher","DOI":"10.1111\/pde.15327"},{"key":"bibr16-24755303241253203","doi-asserted-by":"publisher","DOI":"10.1007\/s41669-019-0152-1"},{"issue":"2","key":"bibr17-24755303241253203","first-page":"123","volume":"15","author":"Mark TL","year":"2009","journal-title":"Am J Manag Care"},{"key":"bibr18-24755303241253203","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2020.07.095"},{"key":"bibr19-24755303241253203","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3181bd4c10"},{"key":"bibr20-24755303241253203","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.27.3.w185"},{"key":"bibr21-24755303241253203","doi-asserted-by":"publisher","DOI":"10.1176\/ps.2009.60.4.520"},{"key":"bibr22-24755303241253203","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-019-01000-w"},{"key":"bibr23-24755303241253203","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2019.25.11.1210"},{"key":"bibr24-24755303241253203","doi-asserted-by":"publisher","DOI":"10.1007\/s13555-021-00573-1"},{"key":"bibr25-24755303241253203","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2023.3804"},{"key":"bibr26-24755303241253203","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2021.27.2.268"},{"key":"bibr27-24755303241253203","doi-asserted-by":"publisher","DOI":"10.3109\/09546630903268247"},{"key":"bibr28-24755303241253203","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp2117582"},{"key":"bibr29-24755303241253203","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2011.17.2.143"},{"issue":"7","key":"bibr30-24755303241253203","first-page":"457","volume":"10","author":"Motheral BR","year":"2004","journal-title":"Am J Manag Care"},{"issue":"1","key":"bibr31-24755303241253203","first-page":"50","volume":"2","author":"Carlton R","journal-title":"Am J Pharm Benefits"},{"key":"bibr32-24755303241253203","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2017.23.8.893"},{"key":"bibr33-24755303241253203","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2008.08.009"},{"key":"bibr34-24755303241253203","doi-asserted-by":"publisher","DOI":"10.3111\/13696998.2013.793692"},{"key":"bibr35-24755303241253203","doi-asserted-by":"publisher","DOI":"10.1111\/papr.12073"}],"container-title":["Journal of Psoriasis and Psoriatic Arthritis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/24755303241253203","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/24755303241253203","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/24755303241253203","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:37:40Z","timestamp":1777509460000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/24755303241253203"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,7]]},"references-count":35,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,7]]}},"alternative-id":["10.1177\/24755303241253203"],"URL":"https:\/\/doi.org\/10.1177\/24755303241253203","relation":{},"ISSN":["2475-5303","2475-5311"],"issn-type":[{"value":"2475-5303","type":"print"},{"value":"2475-5311","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,7]]}}}