Bill > SB837

This bill prohibits managed care organizations, insurers, nonprofit health service plans, and health maintenance organizations from requiring prior authorization, step therapy, or fail-first protocols for prescription drugs that have been reviewed by the Prescription Drug Affordability Board (PDAB) under certain conditions, specifically when the PDAB has not determined the drug causes an affordability challenge, has made a policy recommendation to the General Assembly about the drug, or has set an upper payment limit for the drug. Prior authorization is a process where a health plan must approve a prescription drug before it is dispensed, while step therapy or fail-first protocols require patients to try less expensive drugs first before a more expensive one is covered. The bill also clarifies what constitutes limiting, restricting, or excluding coverage of a prescription drug, including actions like increasing cost-sharing or removing a drug from a formulary (a list of covered drugs), with exceptions for drugs with safety concerns or manufacturing discontinuances. These changes are intended to streamline access to prescription drugs that have undergone review by the PDAB, which aims to make medications more affordable. The provisions related to step therapy and fail-first protocols will take effect on January 1, 2027, while other provisions will take effect on July 1, 2026.