Step Therapy Protocol Exceptions

On March 30, 2017, Gov. Justice signed HB2300 into law. The new law requires health insurance plans which already provide prescription drug coverage and utilize step therapy protocols to implement certain exceptions to those protocols.

The patient and prescribing provider must have access to a clear and convincing process to request a step therapy protocol exception determination. A step therapy override determination must be expeditiously granted if:

  • The required drug will likely cause an adverse reaction or physical/mental harm to the patient.
  • The required drug is expected to be ineffective.
  • The patient has previously tried the required drug and the prescription was discontinued because of lack of efficacy, diminished effect or an adverse event.
  • The required drug is not medically appropriate.
  • The patient is stable on another drug selected by the provider.

The law is effective for policies issued or renewed on or after Jan. 1, 2018.

HB2300 »