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HCS/HB 2029 - Under this act, patients and prescribing practitioners shall have access to a readily accessible process to request a step therapy override exception determination if coverage of a prescription drug for treatment of a medical condition is restricted for use via a step therapy protocol by a health carrier, health benefit plan, or utilization review organization. A "step therapy protocol" is a protocol or program that establishes the specific sequence in which prescription drugs for a specified medical condition and medically appropriate for a particular patient are to be prescribed and paid for by a health carrier or health benefit plan. A "step therapy override exception determination" is a determination as to whether a step therapy protocol should apply in a particular situation or whether such protocol should be overridden in favor of immediate coverage of the prescriber's preferred prescription drug. The act specifies the grounds under which a step therapy override exception request shall be expeditiously granted. The health carrier, health benefit plan, or utilization review organization may request relevant documentation from the patient or provider to support the override exception request. The health carrier, health benefit plan, or utilization review organization shall acknowledge receipt of an override exception request or related appeal and grant or deny such request or appeal within 3 business days of receipt of request or appeal or receipt of supporting documentation. If exigent circumstances exist, the health carrier, health benefit plan, or utilization review organization shall acknowledge receipt of an override exception request or related appeal and grant or deny such request or appeal within 1 business day of receipt of request or appeal or receipt of supporting documentation. If the health carrier, health benefit plan, or utilization review organization does not grant or deny the request or appeal within the time allotted, the request or appeal shall be deemed granted. The provisions of this act shall not be construed to prevent a health carrier, health benefit plan, or utilization review organization from requiring a patient to try a generic equivalent prior to providing coverage for the equivalent branded prescription drug or to prevent a health care provider from prescribing a prescription drug he or she determines is medically appropriate. The Department of Insurance, Financial Institutions and Professional Registration shall enforce the provisions of this act. This act shall only apply to health insurance and health benefit plans delivered, issued for delivery, or renewed on or after January 1, 2017. This act is similar to HB 932 (2015). SARAH HASKINS
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