HB23-1183 Summary

• Establishes a process for Medicaid recipients to request exceptions to step-therapy requirements, which typically require trying lower-cost drugs before coverage of prescribed medications.

• State Department must respond to step-therapy exception requests within 24 hours of receipt; if additional information is needed, provider has 72 hours to respond or the request is denied.

• Prescribing providers can request exceptions based on medical contraindications, lack of efficacy, previous adverse reactions, or patient stability on current medication with supporting clinical documentation.

• Appropriates $56,250 from the general fund and anticipates $168,750 in federal funds for the 2023-24 fiscal year to implement system modifications.

• Allows Department to still require generic equivalents and biosimilars unless a step-therapy exception is granted, and permits providers to prescribe drugs deemed medically appropriate in their clinical judgment.