Bill > H0766

This bill proposes several key changes: 1. It restricts health insurers from requiring individuals to fail on a medication more than once before approving an exception to step-therapy protocols. It also outlines specific conditions under which insurers must grant such exceptions. 2. It requires health insurers to cover at least one readily available asthma controller medication from each class and mode of administration without prior authorization. 3. It establishes standards for how health insurers must process and edit claims, including requiring them to use national coding standards and limiting their ability to downcode claims or conduct prepayment reviews. 4. It prohibits health insurers from imposing prior authorization requirements on services ordered by primary care providers, with some exceptions. 5. It sets new timelines for health insurers to respond to prior authorization requests, and requires approvals to be valid for at least one year. 6. It imposes new transparency requirements for health insurer policies and contracts with providers. The bill also requires reports on the impact of the prior authorization changes on insurers and health care providers.