Limits the use by insurers of step therapy, a protocol that establishes a specific sequence in which prescription drugs for a specified medical condition are covered by an insurer, by allowing medical providers to request step therapy exceptions.
Impact
If enacted, S0116 will enhance patient access to necessary medications and treatments by ensuring that insurers must consider the medical necessity of proposed treatments over internal protocols that could inhibit timely care. This would not only support better health outcomes but could also alleviate stressors on healthcare providers by simplifying the exception request process. Furthermore, the bill ensures that claims are reviewed by healthcare professionals with relevant expertise, which may foster more appropriate medical decisions.
Summary
S0116 is an act relating to insurance, specifically targeted at modifying the protocols around step therapy in healthcare. The bill aims to limit the use of step therapy by insurers and allows healthcare providers to request exceptions to these protocols more easily. Step therapy is a common cost-control measure where insurers require patients to try less expensive options before other prescribed medications are approved. This act mandates that if a provider deems a certain course of treatment medically necessary, insurers must have a prompt process to grant or deny requests for exceptions to step therapy protocols designed to delay or deny care.
Contention
Notably, this legislation may provoke debate among stakeholders in the healthcare and insurance sectors. Proponents of S0116 argue that it is a necessary step towards improving patient care and reducing the bureaucratic hurdles currently faced in the step therapy process. Conversely, opponents may raise concerns about the potential increase in insurance costs and the implications for insurers' ability to manage medication spending. The discussion may revolve around safeguarding patient welfare while balancing the financial sustainability of health insurance practices.
Limits the use by insurers of step therapy, a protocol that establishes a specific sequence in which prescription drugs for a specified medical condition are covered by an insurer, by allowing medical providers to request step therapy exceptions.
Limits the use by insurers of step therapy, a protocol that establishes a specific sequence in which prescription drugs for a specified medical condition are covered by an insurer, by allowing medical providers to request step therapy exceptions.
Defines step therapy and prohibits certain groups and agreements from requiring prior authorization or a step therapy protocol when prescribing certain medications.
Prohibits prior authorization or a step therapy protocol for the prescription of a nonpreferred medication on their drug formulary used to assess or treat an enrollee's bipolar disorder, schizophrenia or schizotypal.
Adds a new section which sets forth conditions for pharmacists to prescribe tobacco cessation/drug therapies, programs approved by the state board of pharmacy. The cessation therapies would be covered by all health insurance carriers on or after 1/1/25.
Adds a new section which sets forth conditions for pharmacists to prescribe tobacco cessation/drug therapies, programs approved by the state board of pharmacy. The cessation therapies would be covered by all health insurance carriers on or after 1/1/25.
Eliminates prior authorization or step therapy requirement for prescriptions for any HIV prevention drug/prohibits the requirement of any copayment or the meeting of any deductible to obtain the prescription covered by the contract, plan, or policy.
Eliminates prior authorization or step therapy requirement for prescriptions for any HIV prevention drug/prohibits the requirement of any copayment or the meeting of any deductible to obtain the prescription covered by the contract, plan, or policy.
Outlines the insurance coverage standards, protocols and guidelines for medically necessary treatment of individuals with mental health or substance abuse use disorders.
Creates the occupational therapy licensure compact that would allow licensed occupational therapists and occupational therapy assistants to practice in all states that join the compact.
Limits the use by insurers of step therapy, a protocol that establishes a specific sequence in which prescription drugs for a specified medical condition are covered by an insurer, by allowing medical providers to request step therapy exceptions.
Limits the use by insurers of step therapy, a protocol that establishes a specific sequence in which prescription drugs for a specified medical condition are covered by an insurer, by allowing medical providers to request step therapy exceptions.
Limits the use by insurers of step therapy, a protocol that establishes a specific sequence in which prescription drugs for a specified medical condition are covered by an insurer, by allowing medical providers to request step therapy exceptions.
Includes the definition of "primary care services" and requires that all biennial reports shall include a review and recommendation of rates for primary care services on and after September 1, 2025.
Includes the definition of "primary care services" and requires that all biennial reports shall include a review and recommendation of rates for primary care services on and after September 1, 2025.