Bill > H0963

This bill, titled the "Florida Patient Protection Act," requires health insurance providers, including Medicaid managed care plans, insurers, and Health Maintenance Organizations (HMOs), to allow a prescribing provider to request an override of a medication restriction imposed through a "step-therapy" or "fail-first" protocol. These protocols, often used by insurers to control costs, require patients to try a less expensive medication first before approving a more specific or expensive one. The bill mandates that insurers must grant an override within 24 hours if the prescribing provider determines the preferred treatment has been ineffective or is likely to be ineffective or cause harm to the patient, based on sound clinical evidence. Furthermore, if a patient enters a step-therapy or fail-first protocol, its duration cannot exceed what the prescribing provider deems appropriate, and if the provider finds the treatment clinically ineffective, the patient is entitled to the recommended therapy without needing an override approval.