Bill > S2120

This bill aims to improve medication management by regulating the use of step therapy protocols by insurance carriers and utilization review organizations. The key provisions include: 1. Requiring clinical review criteria for step therapy protocols to be based on high-quality clinical practice guidelines developed through a transparent process that minimizes conflicts of interest. 2. Providing patients and prescribers with a clear and accessible process to request exceptions to step therapy requirements, which must be granted if certain conditions are met (e.g., the required drug is contraindicated, ineffective, or not in the patient's best interest). 3. Mandating that insurance carriers and utilization review organizations respond to exception requests within 72 hours (24 hours for exigent circumstances), and that the exception is deemed granted if they fail to respond. 4. Clarifying that the bill does not prevent insurers from requiring generic equivalents or providers from prescribing medically appropriate drugs. The bill applies to all health insurance policies, contracts, and certificates issued, delivered, or renewed within the Commonwealth of Massachusetts on or after January 1, 20XX.

https://malegislature.gov/Bills/190/S2120