CS/HB 1001 - Step-therapy Protocols Summary

• Prohibits health insurers and health maintenance organizations from requiring step-therapy protocols for prescription drugs if the insured/subscriber was previously approved for the drug under a separate health plan and that plan paid for it within the preceding 90 days.

• Requires health insurers and HMOs to publish procedures on their websites for requesting protocol exemptions and appeals, including request methods, decision timeframes (within a reasonable time), and appeal procedures.

• Mandates that protocol exemption denials include written explanations of the reason for denial, the clinical rationale supporting the denial, and procedures for appealing the decision.

• Authorizes health insurers and HMOs to request relevant medical records in support of protocol exemption requests.

• Becomes effective July 1, 2021.