HI HB216

Requires health insurers and utilization review organizations to base step therapy protocols (which require patients to try alternative drugs before covering a provider's prescribed medication) on clinical practice guidelines developed by independent expert panels using transparent, evidence-based processes

Mandates insurers provide a clear exception request process when patients are already stabilized on a medication, when required drugs are contraindicated or expected to be ineffective, or when they have previously tried and failed similar drugs

Requires insurers to respond to step therapy exception requests within 72 hours (24 hours for exigent circumstances), with exceptions automatically granted if no determination is made within the deadline

Obligates insurers to annually certify compliance and submit reports to the insurance commissioner detailing the number of exception requests received, approved, denied, and appealed

Applies to all state-regulated health insurance plans issued or renewed after December 31, 2025, covering insurers, mutual benefit societies, and health maintenance organizations