§ 23-79-2101 — 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.

Legislative History

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