Whereas the Rabbinical Assembly Committee on Jewish Law and Standards has articulated the halakhic underpinning for meeting healthcare needs of the community in its “Responsibilities for the Provision of Health Care” teshuvah co-authored by Rabbis Dorff and Mackler, and the Rabbinical Assembly Resolutions Committee has a long history of advocating for health care (Resolution on Suicide and Mental Illness 2019, Resolution on the Opioid Epidemic in America and Canada 2018, Resolution on Health Care, Resolution on Health Care in the United States 2008, Resolution for Health Care for the Poor 2002); and
Whereas in many American jurisdictions a doctor can prescribe a drug or therapy and an insurance company can deny the request, thus requiring the patient to try and possibly fail on the insurance company’s preferred cheaper medicine, including a medical intervention that the patient’s doctor has already prescribed and found to be wanting, for one or more undetermined times until the patient can be approved for coverage prescribed by the doctor in coordination with the patient; and
Whereas step therapy has led to worsened health outcomes for patients including irreversible damage to patients’ bodies. For example, the Washington Post shared the example of a seventh grader in Arizona whose juvenile rheumatoid arthritis spread to the joints in her ribs because she was delayed the appropriate medicine for months due to step therapy;[1] and
Whereas insurance company step therapy protocols can be at odds with what is scientifically recommended by the medical community[2]: and
Whereas Leviticus 19:13 teaches “Do not oppress your fellow” and the Shulchan Arukh Yoreh De’ah 336:1 states that one who prevents someone from saving a life is considered as having killed that person themselves.
Therefore let it be resolved the Rabbinical Assembly supports legislation requiring health plans to provide exemptions and transparent processes to their step therapy protocols, including ensuring that medical science recommendations are followed such as H.R.2630 - 118th Congress (2023-2024): Safe Step Act | Congress.gov | Library of Congress.
Therefore be it further resolved the Rabbinical Assembly encourages members who are in positions to help direct the health insurance purchasing decisions for fellow employees where they work in states and places without step therapy laws, to direct their organizations and synagogues to purchase insurance that has a patient and doctor centered approach to step therapy rules to protect their fellow employees.
[1] Zimmerman, Rachel, “Need a New Drug? You May be Asked to Fail an Old Drug First?” The Washington Post February 6. 2023. Please also see Richards, M A et al. “Influence of delay on survival in patients with breast cancer: a systematic review.” Lancet (London, England) vol. 353,9159 (1999): 1119-26. doi:10.1016/s0140-6736(99)02143-1.
[2] Zimmerman, Rachel, “Need a New Drug? You May be Asked to Fail an Old Drug First?” The Washington Post February 6. 2023