§ 1367.244. — 1367.244. (Amended by Stats. 2021, Ch. 742, Sec. 3.)

California § 1367.244.

• Jurisdiction: California
• Code HSC: Health and Safety Code - HSC
• Div. 2.: DIVISION 2. LICENSING PROVISIONS
• Ch. 2.2.: CHAPTER 2.2. Health Care Service Plans
• Art. 5.: ARTICLE 5. Standards

Text

(a)
A request for an exception to a health care service plan’s step therapy process for prescription drugs may be submitted in the same manner as a request for prior authorization for prescription drugs pursuant to Section 1367.241, and shall be treated in the same manner, and shall be responded to by the health care service plan in the same manner, as a request for prior authorization for prescription drugs.
(b)
The department and the Department of Insurance shall include a provision for step therapy exception requests in the uniform prior authorization form developed pursuant to subdivision (c) of Section 1367.241.
(c)
“Step therapy exception” means a decision to override a generally applicable
step therapy protocol in favor of coverage of the prescription drug prescribed by a health care provider for an individual enrollee.

Legislative History

Amended by Stats. 2021, Ch. 742, Sec. 3. (AB 347) Effective January 1, 2022.