McFall Reintroduces Legislation to Protect Patients by Reforming “Step Therapy” and “Fail First” Insurance Protocols
State Rep. Mike McFall (D-Hazel Park) introduces House Bill 5988 at the Capitol Building in Lansing.
LANSING, Mich., May 15, 2026 — Yesterday, state Rep. Mike McFall (D-Hazel Park) announced the reintroduction of critical legislation aimed at protecting Michigan patients from burdensome insurance practices known as step therapy or “fail first” protocols. The bill, House Bill 5988, seeks to ensure that patients can access the life-saving medications prescribed by their doctors without the unnecessary hurdles often mandated by insurance providers.
Step therapy, often referred to as “fail first,” is a practice used by health insurers that requires patients to try and fail on one or more lower-cost medications before the insurer will cover the original drug prescribed by their healthcare provider. While these protocols are intended to control costs, they often ignore the unique medical needs of individuals, particularly those managing chronic or long-term conditions. By forcing patients to cycle through ineffective treatments, these “fail first” policies can lead to unnecessary suffering and permanent disease progression.
“When a patient is in need of treatment, they should not be forced into a cycle of trial and error dictated by an insurance company,” McFall said. “By reintroducing this legislation, we are continuing our fight to ensure that medical decisions remain between a patient and their doctor. Reforming these “fail first” requirements is about common sense, transparency, and prioritizing patient health over corporate bureaucracy.”
The bill requires insurers to grant or deny a step therapy or “fail first” exception request within 72 hours, or 24 hours in urgent circumstances, ensuring that medical care is not delayed by administrative paperwork. Additionally, it mandates that all step therapy protocols be based on high-quality, peer-reviewed clinical practice guidelines developed by expert multidisciplinary panels, rather than purely financial considerations.
“Across the country, patients continue to face harmful delays and disruptions in care because of rigid step therapy requirements that can override clinical judgment. As a coalition representing more than 20 patient and provider organizations, SAIM supports House Bill 5988 because it establishes commonsense protections that preserve the physician-patient relationship and help patients access the innovative medicines they need without unnecessary barriers,” said Dominique Brown, Co-Chair for the State Access to Innovative Medicines (SAIM) Coalition.
Under the proposed law, patients would receive automatic protections and immediate exceptions if a required “fail first” drug is harmful, likely to cause injury, or if the patient is already stable on their current medication. To ensure accountability, insurers must provide clear, accessible online information regarding their exception processes and submit annual reports to the state regarding the volume and outcomes of these requests. Additionally, the bill addresses the synchronization of maintenance prescription drugs, allowing patients and pharmacists to better coordinate refills for chronic conditions to improve treatment adherence.
“Step therapy takes important treatment decisions out of the hands of doctors and patients. For many patients, delays caused by unnecessary step therapy protocols can lead to irreversible disease progression. We appreciate State Representative McFall’s unwavering leadership in addressing this harmful insurance practice. The Autoimmune Association, which advocates for approximately 1.5 million Michiganders, is pleased to support HB 5988,” said Molly Murray, President and CEO of the Autoimmune Association.
“On behalf of physicians across the state, I’d like to applaud Representative McFall for putting the best interests of Michigan patients first with the introduction of HB 5988 — legislation that will go a long way toward ensuring treatment is driven by clinical evidence and not solely cost considerations,” said Phillip Wise, MD, FACS, president of the Michigan State Medical Society. “Step therapy protocols have for too long allowed insurers to insert themselves into the doctor-patient relationship — delaying or denying access to medically necessary care patients need. This legislation brings long-overdue transparency and fairness to that process, ensuring shared decision-making between the patient and their doctor remains at the center of every treatment plan, and we are proud to support it.”
“This legislation is a vital step toward ending the ‘fail first’ policies that have seen patients’ conditions worsen while they wait for the medicine they need,” McFall added. “We’ve heard the stories of those struggling with these barriers, and we are determined to see these step therapy reforms through to the finish line.”
House Bill 5988 has been introduced and awaits further action in the Michigan House of Representatives.
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