Bill > H492

This bill aims to reduce health care costs through improved medication management. It establishes requirements and restrictions on step therapy protocols used by insurance carriers and utilization review organizations. The key provisions include: - Requiring step therapy protocols to be based on clinical practice guidelines developed by a multidisciplinary panel of experts that manage conflicts of interest. - Providing patients and prescribers with a clear and accessible process to request an exception to the step therapy protocol in certain circumstances, such as if the required drug is contraindicated or expected to be ineffective. - Requiring carriers and utilization review organizations to respond to exception requests within 72 hours, or 24 hours for exigent circumstances, and to authorize coverage for the prescribed drug if the exception is granted. - Allowing carriers to require enrollees to try an AB-rated generic equivalent drug prior to providing coverage for the branded version. The bill applies to all health insurance policies, contracts and certificates delivered, issued or renewed in the state on or after January 1, 20XX.

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https://malegislature.gov/Bills/190/H492