DE HB105

Establishes a step therapy exception process allowing patients and healthcare providers to request bypass of step therapy protocols, which require trying one or more drugs before coverage of a prescribed medication.

Requires insurers and health plans to grant or deny step therapy exception requests within 2 business days (24 hours in emergencies), with requests deemed granted if no response is provided within the timeframe.

Permits exceptions when the required drug is contraindicated, expected to be ineffective, previously failed, not in the patient's best interest, or when the patient is stable on a current medication.

Mandates that step therapy protocols be based on clinical criteria developed by multidisciplinary expert panels using peer-reviewed evidence, with transparent processes that manage conflicts of interest and allow public review.

Applies to individual and group health insurance policies issued or renewed 9 months after enactment, excluding state and federal governmental plans, dental, vision, and disability insurance.