CT HB06831

Insurance companies and health plans must establish a convenient override process for step therapy requests that healthcare providers can use at any time, with written disclosure to providers at least annually and prominent display of override information on provider websites and office bulletin boards.

For schizophrenia, major depressive disorder, and bipolar disorder (as defined by the American Psychiatric Association's Diagnostic and Statistical Manual), step therapy override requests must be granted within 24 hours from the time of request between October 1, 2023 and October 1, 2026.

Override requests for other conditions shall be expeditiously granted when the treating provider demonstrates the step therapy drug regimen has been ineffective, is expected to be ineffective, will cause adverse reactions or harm, or is not in the patient's best interest based on medical necessity.

A task force is established to study data collection efforts regarding step therapy, including edits, rejections, and appeals of behavioral health drugs, with membership including mental health providers, pharmacists, industry representatives, and state officials.

The task force must submit findings and recommendations to the General Assembly's insurance and public health committees by February 1, 2024, at which point it shall terminate.