Bill > S1084

This bill, known as the "Right Medicine Right Time Act," requires managed care plans, insurers, and health maintenance organizations (HMOs) to establish a clear process for prescribing physicians to request an override of certain drug restrictions, specifically those imposed by a "fail-first protocol," which is a practice that starts treatment with the most cost-effective drug and only moves to more expensive or risky options if necessary. These overrides must be granted within 24 hours if the physician provides evidence that the preferred drug was ineffective or is likely to be ineffective or cause harm to the patient. The bill also prohibits HMOs from mandating the use of a "clinical decision support system" (software that assists in medical decision-making) or a "laboratory benefits management program" (a protocol that dictates or limits provider decisions about lab services) to direct or limit a healthcare provider's medical judgment regarding laboratory services, though prior authorization for these services is still permitted.