HB 373 Summary

• Prohibits health insurers and health maintenance organizations from requiring step-therapy protocols or denying coverage for cancer drugs recognized in standard reference compendia or medical literature, even if not FDA-approved for that specific indication.

• Requires health coverage plans to provide an easily accessible online process for step-therapy override requests and must grant or deny such requests within 24 hours for urgent situations or 2 business days for non-urgent situations; deemed approved if plan fails to respond timely.

• Mandates step-therapy override approval when the required drug is contraindicated, ineffective based on patient history, causes adverse reactions or functional harm, patient has failed similar drugs, or patient is stable on the provider's selected drug.

• Prohibits health insurers from retroactively denying claims due to insured ineligibility if eligibility was confirmed at time of treatment or prior authorization was granted, with a 1-year limitation on retroactive denials otherwise.

• Prevents health insurers and health maintenance organizations from imposing additional prior authorization requirements for surgical or invasive procedures and related items furnished during the perioperative period of another procedure for which authorization was already received.

• Effective date: January 1, 2021.