AR SB99

Repeals existing step-therapy requirements from the Arkansas Health Insurance Marketplace and creates comprehensive new regulations for step therapy protocols in Arkansas Code Title 23, Chapter 79, effective January 1, 2022.

Requires step therapy protocols be based on clinical practice guidelines developed by multidisciplinary expert panels that manage conflicts of interest, use high-quality evidence, employ explicit transparent processes, and are continually updated.

Mandates patients and healthcare providers have access to a clear, convenient process to request step therapy protocol exceptions, which must be granted or denied within 72 hours (24 hours in exigent circumstances) based on specific medical criteria including contraindications, ineffectiveness, prior trial failure, or medical necessity.

Prohibits step therapy from being required a second time for the same prescription drug unless a new drug has been introduced or the patient's medical condition has substantially changed, and requires that new pharmacy benefit managers receive historical claims data when hired.

Provides special protections for metastatic cancer patients by prohibiting step therapy requirements unless the preferred drug is consistent with FDA-approved indications or National Comprehensive Cancer Network recommendations.