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HB 459 — Step-therapy Protocols
by Rep. Willhite and others (SB 730 by Senators Harrell, Polsky, and Ausley)
This summary is provided for information only and does not represent the opinion of any Senator, Senate Officer, or Senate Office.
Prepared by: Banking and Insurance Committee (BI)
The bill requires a health insurer or health maintenance organization (HMO) to prescribe the manner, form, and timeframe in which an insured or subscriber may request a protocol exception or exemption and publish such information on its website. A step-therapy protocol is a written protocol used by an insurer or an HMO that specifies the order in which certain medical procedures, treatments, or prescription drugs are used to treat a condition. A protocol exemption is a determination by an insurer or HMO to authorize the use of an alternate procedure, treatment, or prescription drug to treat a condition of an insured or subscriber rather than the procedure, treatment, or drug indicated by the step-therapy protocol.
The bill requires the insurer or HMO to authorize or deny a protocol exemption in a reasonable amount of time. If the insurer or HMO denies the protocol exemption, the insurer or HMO must provide the insured or subscriber with a written response that explains the reason and clinical rationale for the denial and the procedure for appealing a denial.
If approved by the Governor, these provisions take effect July 1, 2022.
Vote: Senate 39-0; House 107-0