CA AB2144

Clarifies that health care service plans and health insurers may require step therapy when multiple appropriate drugs exist for treating a medical condition, and establishes expedited approval criteria for step therapy exceptions including contraindications, expected ineffectiveness, prior failed treatments, medical necessity concerns, and patient stability on current medications.

Requires health care service plans and insurers to respond to prior authorization and step therapy exception requests within 72 hours for nonurgent requests and 24 hours for exigent circumstances, with requests deemed granted if no response is sent within these timeframes.

Allows enrollees, insureds, or their designees, guardians, primary care physicians, or health care providers to appeal prior authorization denials or step therapy exception denials, and requires plans and insurers to designate clinical peers to review such appeals.

Requires health care service plans, health insurers, and utilization review organizations to annually report to their respective departments the number of step therapy exception requests received, reasons for denials, approval rates, and appeal reversals.

Prohibits requiring enrollees or insureds to repeat step therapy when changing contracts if already being treated with a safe and effective drug, though new contracts may impose prior authorization requirements for continued coverage.