MS HB1032

Health coverage plans issued or renewed on or after January 1, 2012 must allow prescribing physicians to request expedited overrides of step therapy or fail-first protocol restrictions on medications.

Insurers must grant an override if the physician demonstrates through clinical evidence that the required preferred treatment has been ineffective or is likely to be ineffective for the patient's condition.

Insurers must grant an override if the physician demonstrates that the preferred treatment will cause or likely cause adverse reactions or physical harm to the patient.

Step therapy or fail-first protocols are limited to 30 days maximum; protocols may be extended up to 7 additional days if the medication requires more than 2 weeks to provide relief.

The act applies to all health insurance policies, HMO contracts, PPO contracts, and group insurance plans and takes effect July 1, 2011.