FL H0963

Requires Medicaid managed care plans, insurers, and health maintenance organizations to provide prescribing providers a clear process to request overrides of step-therapy or fail-first medication protocols

Mandates that override requests must be granted within 24 hours when the prescribing provider determines the preferred treatment has been ineffective, is likely to be ineffective based on the patient's characteristics, or will cause adverse reactions or physical harm

Limits the duration of step-therapy or fail-first protocols to the time period deemed appropriate by the prescribing provider, not the insurer

Allows patients to receive their recommended course of therapy without requiring a formal override request if the prescribing provider deems the step-therapy treatment clinically ineffective

Effective date: July 1, 2016