Researcher: JO Page 1 3/13/24
OLR Bill Analysis
sSB 182
AN ACT PROHIBITING CERTAIN HEALTH CARRIERS FROM
REQUIRING STEP THERAPY FOR PRESCRIPTION DRUGS USED
TO TREAT A MENTAL OR BEHAVIORAL HEALTH CONDITION OR
A CHRONIC, DISABLING OR LIFE-THREATENING CONDITION.
SUMMARY
Step therapy is a prescription drug protocol that generally requires
patients to try less expensive drugs before higher-cost drugs. This bill
prohibits individual and group health insurance policies or contracts
from requiring the use of step therapy for drugs used to treat a mental
or behavioral health condition or a chronic, disabling, or life-threatening
condition or disease, as long as the drug complies with approved Food
and Drug Administration indications. Existing law already prohibits
health carriers (e.g., insurers and HMOs) from requiring the use of step
therapy for (1) stage IV metastatic cancer (indefinitely) or (2)
schizophrenia, major depressive disorder, or bipolar disorder (until
January 1, 2027).
For drugs prescribed for other conditions, the bill reduces how long
a carrier can require an insured to use step therapy from 30 to 20 days.
Under the bill, as under existing law, a patient’s provider can deem
step therapy as clinically ineffective for the patient (immediately for the
prohibited conditions or at the end of the waiting period for other
conditions), at which point the carrier must cover the drugs prescribed
by the provider, as long as they are covered under the insurance policy
or contract. If the provider does not consider the step therapy regimen
to be ineffective or does not request an override as the law allows, the
regimen may be continued.
The bill applies to individual and group health insurance policies or
contracts that provide coverage for prescription drugs and are 2024SB-00182-R000020-BA.DOCX
Researcher: JO Page 2 3/13/24
delivered, issued, renewed, amended, or continued by an insurer,
hospital or medical service corporation, health care center (i.e., HMO),
or other entity.
EFFECTIVE DATE: January 1, 2025
COMMITTEE ACTION
Public Health Committee
Joint Favorable Substitute
Yea 30 Nay 7 (03/04/2024)