An Act relating to insurance; providing for step
therapy reform; defining terms; directing providers
to establish guidelines; providing for exceptions;
providing for response to requests; directing
Insurance Department to promulgate rules; providing
for codification; and providing an effective date. The measure requires that health plans beginning in 2020 adopt guidelines governing step therapy. These guidelines will
include criteria relating to the procedure determining medical necessity for step therap. The guidelines must be endorsed by a panel of unbiased experts (or peer-reviewed publications), research-based, and created through a transparent process. The measure further requires that for
any prescription drug coverage restriction under a health plan, the insurer must provide an accessible process to request a step therapy exemption.