Step therapy protocol; defining terms; requiring health benefit plans to implement a new process; exceptions to protocol; information; effective date.
Impact
The bill is poised to impact how health benefit plans administer their treatment protocols. It could potentially lead to quicker access to necessary treatments for patients who can demonstrate that a prescribed protocol is not effective or could be harmful to their health. The emphasis on a defined process and timelines for responses to exception requests aims to enhance compliance among healthcare providers and better serve the needs of patients requiring immediate or alternative therapies.
Summary
House Bill 1736, focusing on step therapy protocols, mandates that health benefit plans in Oklahoma develop a transparent process for participants or their healthcare providers to request exceptions to treatment protocols. This bill particularly addresses patients with chronic respiratory failure due to chronic obstructive pulmonary disease (CRF-COPD), ensuring that those affected can receive necessary treatments without undue delays. By defining key terms and setting standards, the bill aims to streamline the way exceptions to standard treatment protocols are handled, thereby improving patient access to effective care.
Sentiment
Overall, the sentiment surrounding HB 1736 appears to be positive, particularly among advocacy groups focusing on patient care and rights. Supporters of the bill feel that it provides necessary protections for patients, allowing for flexibility in treatment based on individual health needs. However, there may be some concerns regarding how health plans implement these requirements, particularly in terms of maintaining efficiency and transparency in the exception process.
Contention
While the bill seems to enjoy broad support for its consumer protection aspects, there could be contention regarding its implementation and the additional burdens it may place on health benefit plans. Ensuring compliance within the specified timeframes and processes could be challenging for some plans, leading to fears about whether the intent to expedite patient care can be fully realized without incurring additional costs or complications.
Carry Over
Step therapy protocol; defining terms; requiring health benefit plans to implement a new process; exceptions to protocol; information; effective date.
Behavioral health; requiring health insurer to cover certain out-of-network services under certain circumstances; providing exceptions. Effective date.
Public health and safety; step therapy requirements for certain drugs for certain conditions; definitions; authorizing a health benefit plan to allow coverage for prescription drugs for advanced metastatic cancer and associated conditions without proving step therapy; effective date.
Health benefit plan directories; directing plans to publish certain information in a publicly accessible manner; requiring reporting to Insurance Commissioner. Effective date.