Bill > HB216

This bill establishes comprehensive requirements for step therapy protocols in health insurance plans in Hawaii, aimed at protecting patients and ensuring more flexible, patient-centered prescription drug coverage. The bill requires that clinical review criteria for step therapy protocols be based on high-quality, scientifically rigorous clinical practice guidelines developed by experts who manage potential conflicts of interest. It creates a clear process for patients and healthcare providers to request exceptions to step therapy protocols, mandating that insurers grant exceptions in specific circumstances, such as when a patient is already stabilized on a particular medication or when the required drug would likely cause harm or be ineffective. The bill requires insurers to make exception determinations quickly (within 72 hours, or 24 hours in urgent cases) and to provide transparent documentation of their clinical review criteria. Additionally, insurers must annually report to the insurance commissioner detailed statistics about step therapy exception requests, including the number of requests received, denied, and approved, as well as the medical conditions involved. The legislation applies to all state-regulated health insurance plans and aims to ensure that step therapy protocols are fair, consistent, and prioritize patient health and individual medical needs.

Health and Social Services

https://www.capitol.hawaii.gov/session/measure_indiv.aspx?billtype=HB&billnumber=216&year=2025