Oncology nurse in New Jersey, Anne Shaftic, has written about the dangers of step therapy, a practice used by insurance companies and pharmacy benefit managers, such as OptumRx, CVS Caremark and Express Scripts, which forces patients to try a cheaper drug first before they can access the treatment their doctor has prescribed. Step therapy, also known as “fail first”, is often used to prevent patients from being stuck on the wrong drug or being unable to access the drug their doctor prescribed. A recent survey of cancer care professionals found that nearly 100% have seen patients struggle directly due to insurer-imposed step therapy. The Safe Step Act, which would require insurers to respect a physician's judgment when step therapy puts a patient at risk, would be introduced in the U.S. Congress has passed bipartisan legislation aimed at reining in PBMs, but enforcement is lacking.