Rhode Island House Bill H7822

Rhode Island 2024 Regular Session

• Introduced: 3/1/24
• Refer: 3/1/24

Caption

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 passed, HB 7822 is expected to significantly alter how insurers manage the approval process for medications and treatments, potentially leading to quicker access to medically necessary services for patients. The proposed changes would enhance oversight and ensure that exceptions to the step therapy protocols are granted when certain conditions are met, such as when a prescribed treatment is contraindicated or has proven ineffective. Furthermore, it imposes a requirement for insurers to process exception requests rapidly, with specific time frames established for both urgent and non-urgent cases, thus promoting better healthcare outcomes for patients who might otherwise be delayed by insurers’ previous protocols.

Summary

House Bill 7822 proposes to amend the Benefit Determination and Utilization Review Act, specifically targeting the protocols surrounding step therapy used by insurers. The bill seeks to limit the application of step therapy, a protocol which dictates the sequence in which prescription drugs are covered by insurers for specific medical conditions. By allowing medical providers to request exceptions to the step therapy requirement, the bill aims to ensure that patients receive timely and appropriate care without unnecessary delays imposed by insurance companies. This legislative effort underscores the importance of patient-centered treatment decisions made collaboratively between healthcare providers and their patients.

Contention

While the bill is poised to improve patient access to necessary medications, it may also face opposition from insurance companies that argue that the current step therapy protocols are essential for managing costs and ensuring the efficacy of treatments. Critics may raise concerns about the administrative burden placed on insurers, and whether the expedited processes could lead to increased costs. Additionally, the ultimate effectiveness of the legislation will rely on robust enforcement mechanisms and compliance from insurers, which could become a topic of debate among stakeholders as the bill moves forward.