HI HB1289

Establishes minimum standards for step therapy protocols used by health insurers and utilization review organizations to require patients to try alternative drugs before coverage is approved.

Requires clinical review criteria for step therapy protocols to be based on clinical practice guidelines developed by multidisciplinary expert panels that manage conflicts of interest and employ transparent, evidence-based processes.

Mandates insurers and utilization review organizations provide patients and prescribers with accessible processes to request exceptions to step therapy requirements, with determinations made within 72 hours (or 24 hours in urgent situations).

Requires step therapy exceptions be granted if a patient's condition is stabilized on a prescribed drug, or if the required alternative drug is contraindicated, expected to be ineffective, previously failed, or not in the patient's best medical interest.

Requires all insurers and mutual benefit societies to certify annually to the insurance commissioner that their step therapy protocols meet these requirements and submit proposed changes for approval before implementation.