FL S1290

Requires health insurers and health maintenance organizations to establish procedures for insured individuals and health care providers to request exemptions from step-therapy protocols, including making prior authorization forms available.

Mandates exemption requests be granted or denied within 72 hours for nonurgent care and 24 hours for urgent care situations, with detailed written explanations required for denials.

Establishes five conditions requiring automatic approval of protocol exemptions: contraindication or adverse reactions, expected ineffectiveness, prior failed treatment in same drug class, barrier to treatment adherence, or substitution of nonopioid for opioid treatment.

Allows health insurers and HMOs to request medical documentation supporting exemption requests but does not require them to add drugs to formularies or cover drugs lacking FDA approval.

Effective July 1, 2021.