Bill > HB1638

This bill creates a comprehensive framework for regulating step therapy protocols in health insurance, focusing on establishing clear guidelines for when and how insurers can require patients to try less expensive prescription drugs before covering more costly medications. The bill defines key terms like "step therapy protocol" (a specific sequence of prescription drugs for a medical condition) and "medically necessary" (treatments that improve or preserve health), and establishes detailed requirements for how insurers must develop and apply these protocols. Specifically, the bill mandates that step therapy clinical review criteria must be based on high-quality medical research, developed by experts who disclose potential conflicts of interest, and continuously updated. It also creates a mandatory exceptions process that requires insurers to quickly grant override requests under certain circumstances, such as when a required drug might cause adverse reactions, is expected to be ineffective, or when a patient is already stable on a different medication. Notably, the bill provides special protections for patients with advanced, metastatic cancer, prohibiting step therapy protocols for certain drugs that meet specific clinical standards. The bill aims to balance cost management for insurers with ensuring patients can access the most appropriate medical treatments, and it will take effect 90 days after passage.

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https://gc.nh.gov/bill_Status/billinfo.aspx?id=2241&inflect=2