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STATE OF OKLAHOMA
1st Session of the 59th Legislature (2023)
HOUSE BILL 1736 By: Townley
AS INTRODUCED
An Act relating to step therapy protocol; providing
for exceptions to step therapy protocol; providing
for codification; and provi ding for an effective
date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 7330 of Title 63, unless there
is created a duplicat ion in numbering, reads as follows:
No health benefit plan, health maintenance organiz ation,
preferred provider organiza tion, or other provider network
authorized to administer health care coverage in this state sh all
require treatment following step thera py protocol when any of the
following exceptions are present:
1. Any treatments otherwise required under the protocol have
not been shown to be as eff ective as other available options in the
treatment of the disease or condition o f the participant or
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beneficiary, when prescribed consistent with clinical directions,
clinical guidelines, or other peer-reviewed evidence;
2. Delay of proven effective treatment would lead to severe or
irreversible consequences, and the treatment initially required
under the protocol is reasonably expe cted to be less effective
based upon the documented physical or mental characteristics of the
participant or beneficiary and the known characteristics of such
treatment;
3. Any treatments otherwise required under the protocol are
contraindicated for the participant or beneficiary or have caused,
or are likely to cause, based on clinical, peer -reviewed evidence,
an adverse reaction or other physical harm to the participant or
beneficiary;
4. Any treatment otherwise required under the protocol has
prevented, will prevent, or is likely to prevent a participant or
beneficiary from achieving or mainta ining reasonable and safe
functional ability in performing occupational responsibilities or
activities of daily living as defined in 42 CFR, Section 441.505, or
successor regulations ;
5. The participant or beneficiary i s stable for his or her
disease or condition on the prescription drug or drugs selected by
the prescribing health care provider and has previously received
approval for coverage of the relevant dr ug or drugs for the disease
or condition; or
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6. The patient and devices require frequent and sub stantial
services.
SECTION 2. This act shall become effective November 1, 2023.
59-1-5330 TJ 01/14/23