AZ SB1270

Creates new Chapter 30 of Title 20 Arizona Revised Statutes establishing requirements for health care insurers, pharmacy benefit managers, and utilization review agents using step therapy protocols for prescription drug coverage.

Requires clinical review criteria for step therapy protocols to be based on clinical practice guidelines developed by multidisciplinary expert panels with conflict of interest management, methodologist involvement, and annual updates with high-quality evidence.

Establishes a clear exception process allowing patients and prescribing providers to request step therapy exceptions based on contraindications, ineffectiveness, prior unsuccessful trials, comorbid condition impacts, or positive therapeutic outcomes on alternative drugs.

Mandates step therapy exception decisions be made within 72 hours (or 24 hours for exigent circumstances), with automatic approval if no determination or information request is received within the required timeframe.

Requires annual certification to the Department that clinical review criteria meet statutory requirements, with insurers jointly responsible for pharmacy benefit managers and utilization review agents' compliance.

Applies to health care plans delivered, issued, or renewed on or after December 31, 2022.