Eczema Access: NEA Advocates for Step Therapy Reform & Funding

For millions living with eczema, navigating the condition itself is only half the battle. Increasingly, patients and their families are finding themselves locked in frustrating disputes with insurance companies over access to necessary treatments, a challenge that advocates say demands legislative solutions.

Recent meetings on Capitol Hill, spearheaded by the National Eczema Association (NEA), highlighted the persistent hurdles patients face, even as medical advancements offer latest hope. These barriers aren’t simply inconveniences; they can lead to uncontrolled symptoms, increased risk of infection, and a significant decline in quality of life.

Insurance Obstacles Remain Widespread

According to NEA’s 2025 survey, a substantial 40% of individuals with eczema and their caregivers reported experiencing at least one insurance-related coverage issue within the past year. The impact is significant: 12% were forced to discontinue a prescribed medication due to coverage limitations, and a concerning 15% never even initiated a prescription because of insurance roadblocks. These findings underscore a systemic problem that extends beyond individual cases.

A particularly contentious practice is “step therapy,” where insurers require patients to attempt – and fail – on less expensive medications before approving the treatment their dermatologist initially prescribed. More than one-third of survey respondents cited step therapy as a major obstacle. Nearly one in four patients had to request a retry of a previously failed medication, and over half encountered prior authorization requirements, adding layers of administrative burden and delay.

The Safe Step Act: A Potential Path Forward

The NEA is actively advocating for the passage of the Safe Step Act, reintroduced in Congress in September 2025. This bipartisan legislation aims to reform step therapy policies by mandating a timely exceptions process when such protocols are not in a patient’s best interest. The goal is to ensure that medical decisions are driven by clinical need, not cost considerations.

“Treatment innovations for people with eczema have been amazing, but legislation and insurance policies have not been as innovative,” explains Kristin Belleson, MBA, CAE, president and CEO of NEA. “Our goal was to highlight this burden posed to patients with eczema, and discuss solutions to improve patient outcomes, insurance barriers, treatment delays and the need for increased research funding.”

Beyond Step Therapy: A Multifaceted Problem

While step therapy is a prominent issue, it’s not the only challenge. Prior authorization, where insurers require doctors to obtain approval before prescribing a medication, also creates significant delays and administrative burdens. The NEA survey revealed that 56% of patients faced prior authorization barriers. These processes can disrupt treatment plans, exacerbate symptoms, and ultimately impact patients’ well-being.

Belleson emphasizes the broader implications of these access issues. “Not only does this impact patients but it also affects health care systems. When patients with eczema cannot receive the treatment they need, they can experience complications like staph infections, making the disease more significant than if they had just received treatment earlier.”

The Emotional Toll of Eczema and Access Barriers

The NEA survey also shed light on the emotional burden of eczema, which is often underestimated. A significant proportion of patients report experiencing anxiety, social withdrawal, and missed activities when their symptoms are not adequately controlled. The added stress of navigating insurance hurdles can further exacerbate these emotional challenges.

Belleson notes a growing awareness of the emotional impact of eczema, fueled in part by online communities and “skin influencers” who share their experiences. However, she also acknowledges that social media can sometimes amplify feelings of inadequacy and self-consciousness.

What Can Be Done? Advocacy and Awareness

The NEA is urging dermatologists and other healthcare professionals to get involved in advocacy efforts. This includes educating policymakers about insurance barriers, participating in NEA or American Academy of Dermatology advocacy initiatives, contacting legislators, and submitting comments on proposed policies. Healthcare providers can also play a crucial role by informing patients about their rights and supporting them through the appeals process.

“Health care professionals play a critical role in advocacy and can make a difference by educating policymakers about insurance barriers,” Belleson states. “They can also educate their patients and let them understand that they have someone who is on their side, working on these issues.”

Looking Ahead: Continued Advocacy and Research

The NEA’s advocacy efforts are ongoing, with a focus on securing passage of the Safe Step Act and increasing federal research funding for eczema. The organization is also committed to raising awareness about the condition and its impact on patients’ lives. More information about the NEA’s work and resources for patients can be found on their website.

Belleson concludes, “Eczema is way more than a cosmetic or minor skin issue. This proves a chronic inflammatory disease that affects so many different parts of people’s lives…Skin is a part of everything we do. We are so lucky to have treatments that have advanced over the last 7 to 10 years, but our policy is still lagging. We need to continue to keep pace with science so that health care professionals can feel comfortable prescribing necessary treatments for their patients.”

Kristin Belleson, MBA, CAE, can be reached at [email protected].