CT HB05275

Health carriers cannot require step therapy for prescribed drugs treating mental or behavioral health conditions if the drugs comply with FDA-approved indications, effective January 1, 2023.

Health carriers cannot require step therapy for any prescribed drug longer than 60 days or for stage IV metastatic cancer treatments meeting FDA requirements.

Treating health care providers may request an override of step therapy requirements at any time, which must be expeditiously granted if the provider demonstrates the required drug has been ineffective, is expected to be ineffective, will cause harm, or is not in the patient's best interest.

Health carriers must establish and disclose a convenient override process to their health care providers for requesting exceptions to step therapy protocols.

Provisions apply to both individual health insurance policies (Section 38a-510) and group health insurance policies (Section 38a-544).