Bill > SB483

This bill generally revises health care laws by introducing comprehensive regulations for step therapy protocols in health insurance. The legislation defines step therapy as a protocol requiring patients to try specific prescription drugs in a predetermined sequence before insurance will cover a preferred medication. The bill establishes detailed requirements for how insurers can develop and implement step therapy protocols, mandating that these protocols must be based on clinical practice guidelines developed by multidisciplinary expert panels with transparent processes to minimize bias and conflicts of interest. It provides patients and healthcare providers with a clear mechanism to request exceptions to step therapy protocols if the required medications are likely to cause adverse reactions, are ineffective, or do not serve the patient's best medical interests. The bill requires insurers to make exception determinations quickly (within 72 hours, or 24 hours in urgent cases), and mandates that insurers annually report on their step therapy exception request data to the state. Additionally, the bill amends existing definitions in Montana's health care laws, adding new terms related to step therapy, generic drugs, and medical appropriateness. The overall aim is to provide more patient-centered and clinically sound approaches to prescription drug coverage, ensuring that insurance protocols are based on high-quality medical evidence and individual patient needs.

Business and Industry

https://bills.legmt.gov/#/laws/bill/2/LC3324