HB 2420 Summary

• Adds Chapter 28 to Title 20 of Arizona Revised Statutes to regulate step therapy protocols used by health insurers, pharmacy benefits managers, and utilization review organizations for prescription drug coverage.

• Requires clinical review criteria for step therapy protocols to be based on evidence-based clinical practice guidelines developed by multidisciplinary expert panels that manage conflicts of interest and use high-quality research.

• Establishes a clear exception request process allowing patients and prescribers to request step therapy exceptions, which must be granted if the required drug is contraindicated, ineffective, previously discontinued due to lack of efficacy or adverse events, not medically necessary, or the patient was stable on an alternative drug.

• Mandates insurers respond to step therapy exception requests within 72 hours (or 24 hours for exigent circumstances), and deems exceptions automatically granted if the insurer fails to respond within the required timeframe.

• Applies to health care plans delivering, issued for delivery, or renewed on or after December 31, 2021.