Rhode Island Senate Bill S2611

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 enacted, S2611 would have significant implications for patient access to care in Rhode Island. By restricting the use of step therapy, the bill empowers healthcare providers to make decisions based on individual patient needs rather than insurance protocols. This could lead to faster access to necessary medications and treatments for patients who might otherwise face roadblocks to essential care due to insurance restrictions. The bill also mandates insurers to provide a clear process for submitting exception requests, aiming to enhance transparency in how healthcare decisions are managed by insurers.

Summary

S2611 seeks to amend existing insurance regulations in Rhode Island concerning the use of step therapy protocols. Step therapy, which requires patients to try less expensive or alternative medications before coverage is granted for more costly treatments, is a common practice employed by insurers. The bill aims to limit the application of these protocols by enabling healthcare providers to request exceptions based on the medical necessity of treatments, ensuring that patients receive timely care without unnecessary delays from insurer mandates.

Contention

However, the bill is likely to face opposition from insurers who may argue that step therapy is a necessary tool for managing costs and ensuring appropriate treatment paths. Proponents of the bill argue that step therapy can often delay critical interventions and negatively impact patient health outcomes. This tension highlights a broader debate over how healthcare is administered and financed, particularly in terms of balancing costs with access to timely and necessary medical care.