NC H450

Requires health benefit plans to impose the same prior authorization requirements for abuse-deterrent opioid analgesics as for non-abuse-deterrent opioids, and prohibits plans from requiring patients to use non-abuse-deterrent opioids before covering abuse-deterrent alternatives.

Establishes that step therapy protocols must be based on clinical practice guidelines developed by independent, multidisciplinary expert panels and must consider high-quality evidence, patient subgroups, and explicit transparent processes.

Requires health benefit plans to grant step therapy override requests expeditiously if the required drug is contraindicated, expected to be ineffective, previously failed, not medically appropriate, or if the patient is stable on an alternative drug.

Mandates health benefit plans respond to step therapy exception requests and appeals within 72 hours (or 24 hours in exigent circumstances), with requests deemed granted if no response is provided within the required timeframe.

Becomes effective October 1, 2019, and applies to insurance contracts issued, renewed, or amended on or after that date.