Bill > SB226

This bill establishes comprehensive requirements for step therapy protocols in health insurance plans in Hawaii, aiming to protect patients and ensure fair, transparent prescription drug coverage. The legislation requires insurers to base step therapy protocols on high-quality, scientifically-developed clinical practice guidelines that are created by multidisciplinary expert panels with strict conflict of interest management. Patients and healthcare providers will have a clear process to request exceptions to step therapy protocols when the prescribed medication is medically necessary or when the required alternative drugs could cause harm. Insurers must make exception determinations within 72 hours (or 24 hours in urgent cases), provide detailed clinical review criteria upon request, and annually report on step therapy exception requests. The bill allows exceptions when a patient is currently stabilized on a particular drug, when alternative drugs might cause adverse reactions, or when the prescribed drug is deemed medically most appropriate. Additionally, the legislation requires insurers to certify their step therapy protocols to the insurance commissioner and ensures that healthcare providers can still prescribe medications they believe are most suitable for their patients. The law will apply to all health insurance and health benefit plans issued or renewed in Hawaii after December 31, 2025.

Health and Social Services

https://www.capitol.hawaii.gov/session/measure_indiv.aspx?billtype=SB&billnumber=226&year=2025