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FL S0528
Bill
AI Summary
- Prohibits health insurers and HMOs from requiring step-therapy (fail-first) protocols for stage 4 metastatic cancer treatment drugs and associated conditions, and bars exclusion of cancer drugs recognized in standard reference compendia or medical literature
- Requires prior authorization decisions within 72 hours for nonurgent care and 24 hours for urgent care situations, with notification to both the patient and treating provider
- Establishes mandatory step-therapy protocol exception procedures, requiring insurers and HMOs to grant exceptions when a preceding drug is contraindicated, expected to be ineffective, would worsen a comorbid condition, or involves an opioid where a nonopioid alternative exists
- Prohibits retroactive claim denials at any time if the insurer verified eligibility at the time of treatment or provided an authorization number, and bars additional prior authorization requirements for procedures or items furnished during the perioperative period of an already-authorized surgery
- Requires insurers and pharmacy benefits managers to publish prior authorization requirements on a public website and provide at least 60 days' written notice before implementing new or changed prior authorization restrictions, effective January 1, 2022
Legislative Description
Health Insurance Prior Authorization
Last Action
Died in Banking and Insurance
4/30/2021
Committee Referrals
Banking and Insurance1/21/2021
Full Bill Text
No bill text available