Rhode Island Senate Bill S0116

Rhode Island 2025 Regular Session

• Introduced: 1/31/25
• Refer: 1/31/25

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, 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.