HB 559 – Relating to Step Therapy Protocols

On Tuesday, March 19, HB 559 by Representative Ralph Massullo, Jr. (R-Beverly Hills) was heard before the House Health Market Reform Subcommittee and was reported favorably with 14 yeas and 0 nays. AIF supports the adopted amendment on the underlying bill and stood in support of this legislation.

Insurers and health maintenance organizations (HMOs) use many cost management strategies to manage drug spending. For example, step therapy is when a health insurance plan requires an individual to try a preferred drug before using a nonpreferred drug.

This bill states that a health insurer may not impose a step-therapy protocol for a covered prescription drug if:

• The insured has been approved to receive the prescription drug through a step-therapy protocol imposed by a health insurer that previously issued major medical coverage to the insured; and,
• The insured is currently taking the drug and is documented by the health insurer that approved the drug.
  
  

This does not preclude an insureds new health insurer from imposing a prior authorization requirement for the continued coverage of a drug prescribed and a health insurer is not required to add a drug to its prescription drug formulary, or to cover a prescription drug's use if it is not currently covered.

This bill also requires health insurers and pharmacy benefit managers to establish and offer an online prior authorization process for step therapy exceptions.

HB 559 will now move to the House Appropriations Committee.

AIF supports an online prior authorization form for continued flexibility for health plans to ensure consumers receive high quality, high value and affordable care, through continued use of innovative plan designs.