An Act Concerning Step Therapy, Adverse Determination And Utilization Reviews.
If enacted, SB00028 would significantly alter how health insurance companies handle prior authorization processes, especially concerning psychiatric treatments and chronic disease management. By shifting the burden of proof from patients to health carriers, the bill mandates that insurers must justify their claims that particular services or treatments are not medically necessary, thereby potentially reducing the number of denied claims based on adverse determinations. This could lead to better access to care for patients who require immediate and effective treatments.
Bill SB00028, titled 'An Act Concerning Step Therapy, Adverse Determination And Utilization Reviews,' seeks to reform the practices employed by health carriers regarding step therapy for medications prescribed for behavioral health conditions as well as chronic, disabling, or life-threatening conditions. The primary focus of the bill is to prevent health insurers from mandating step therapy for certain prescribed drugs, thus allowing doctors and patients more flexibility in treatment choices without being constrained by insurers’ requirements.
There are likely points of contention surrounding the implementation of SB00028. Proponents argue that it is a necessary step toward improving patient autonomy and reducing bureaucratic hurdles in accessing necessary medications, particularly for vulnerable populations suffering from significant health issues. However, opponents may raise concerns about potential increases in insurance costs or overuse of treatments that might not be essential, fearing that easing restrictions could lead to unnecessary prescriptions. The discourse is expected to explore a balance between ensuring access to necessary treatments and maintaining responsible insurance practices.