CT HB06545

Commissioner of Social Services may establish a step therapy program for Medicaid prescription drugs, requiring patients to try and fail on only one preferred drug before another drug can be prescribed and covered.

Step therapy program does not apply to mental health-related drugs or drugs prescribed for ongoing conditions where the patient has filled a prescription for the same drug within the preceding 180 days.

Prescribing practitioners must have access to a clear process to request expedited overrides when the preferred treatment has been ineffective, is expected to be ineffective, will cause adverse reactions, or when medical necessity requires alternative therapy.

Step therapy requirements expire after seven days, after which the prescribing practitioner may deem the treatment clinically ineffective and the recommended drug must be dispensed and covered under Medicaid.

Effective July 1, 2013.