NH HB1638

Requires health insurers and utilization review organizations to provide a clear process for enrollees and prescribers to request exceptions to step therapy protocols, which mandate trying certain drugs in a specific sequence before covering a preferred medication

Mandates insurers grant step therapy override exceptions when the required drug is contraindicated, expected to be ineffective, previously tried without success, not in the patient's best interest, when the patient is stable on their current medication, or when treating serious mental illness

Requires insurers to respond to exception requests within 72 hours for urgent cases, 24 hours for emergencies, 7 days for non-urgent electronic requests, and 14 days for non-urgent non-electronic requests, with automatic approval if deadlines are missed

Prohibits step therapy protocols entirely for FDA-approved prescription drugs treating advanced, metastatic cancer and associated conditions when supported by peer-reviewed evidence and best practices

Requires clinical review criteria for step therapy protocols to be based on evidence-based guidelines developed by expert panels with conflict-of-interest safeguards and public comment opportunities