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SB 11 – New Mexico

Status: Enacted
Year Introduced: 2018
Link: https://www.nmlegis.gov/Legislation/Legislation?chamber=S&legType=B&legNo=11&year=18

RELATING TO STEP THERAPY FOR PRESCRIPTION DRUG COVERAGE: When a group health plan restricts coverage of a prescription drug for the treatment of any medical condition through the use of a step therapy protocol, an enrollee and the practitioner prescribing the prescription drug shall have access to a clear, readily accessible and convenient process to request a step therapy exception determination. A group health plan shall expeditiously grant an exception to the group health plan’s step therapy protocol, based on medical necessity and a clinically valid explanation from the patient’s prescribing practitioner as to why a drug on the plan’s formulary that is therapeutically equivalent to the prescribed drug should not be substituted for the prescribed drug, if certain criteria are met.


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