Legislative findings and intent

(a) The General Assembly finds that: (1) Health benefit plans are increasingly making use of step therapy protocols under which patients are required to try one (1) or more prescription drugs before coverage is provided for a drug selected by the patient's healthcare provider; (2) Such step therapy protocols, if the step therapy protocols are based on well-developed scientific standards and administered in a flexible manner that takes into account the individual needs of a patient, can play an important role in controlling healthcare costs; and (3) Without uniform policies in the state for step therapy protocols, a patient may not receive the equivalent or most appropriate treatment. (b) It is the intent of the General Assembly that: (1) To require healthcare insurers to base step therapy protocols on appropriate clinical practice guidelines or published peer-reviewed data developed by independent experts with knowledge of the condition or conditions under consideration is a matter of public interest; and (2) Patients have access to a fair, transparent, and independent process for requesting a step therapy protocol exception when the patient's physician deems it appropriate. Added by Act 2021, No. 97,§ 2, eff. 1/1/2022.

(a) The General Assembly finds that: (1) Health benefit plans are increasingly making use of step therapy protocols under which patients are required to try one (1) or more prescription drugs before coverage is provided for a drug selected by the patient's healthcare provider; (2) Such step therapy protocols, if the step therapy protocols are based on well-developed scientific standards and administered in a flexible manner that takes into account the individual needs of a patient, can play an important role in controlling healthcare costs; and (3) Without uniform policies in the state for step therapy protocols, a patient may not receive the equivalent or most appropriate treatment.

(1) Health benefit plans are increasingly making use of step therapy protocols under which patients are required to try one (1) or more prescription drugs before coverage is provided for a drug selected by the patient's healthcare provider;

(2) Such step therapy protocols, if the step therapy protocols are based on well-developed scientific standards and administered in a flexible manner that takes into account the individual needs of a patient, can play an important role in controlling healthcare costs; and

(3) Without uniform policies in the state for step therapy protocols, a patient may not receive the equivalent or most appropriate treatment.

(b) It is the intent of the General Assembly that: (1) To require healthcare insurers to base step therapy protocols on appropriate clinical practice guidelines or published peer-reviewed data developed by independent experts with knowledge of the condition or conditions under consideration is a matter of public interest; and (2) Patients have access to a fair, transparent, and independent process for requesting a step therapy protocol exception when the patient's physician deems it appropriate.

(1) To require healthcare insurers to base step therapy protocols on appropriate clinical practice guidelines or published peer-reviewed data developed by independent experts with knowledge of the condition or conditions under consideration is a matter of public interest; and

(2) Patients have access to a fair, transparent, and independent process for requesting a step therapy protocol exception when the patient's physician deems it appropriate.

Added by Act 2021, No. 97,§ 2, eff. 1/1/2022.