Override Exceptions for Step Therapy Protocol

On May 10, 2017, Gov. Reynolds signed HB 233 into law. The new law provides that when a step therapy protocol is in use, plan participants and prescribing health-care practitioners must be able to request a step therapy exception or override determinations under certain conditions.

As background, step therapy involves protocols or programs that establish a specific order in which prescription drugs are prescribed. This bill requires plans that cover prescription drugs through step therapy to allow participants and their practitioners to request step therapy override exceptions. Specifically, the participant must be allowed to request, in writing, that step therapy be overridden in a particular situation where immediate coverage of prescription drugs would be more medically appropriate. The override exception requests must be granted if the plan participant previously received step therapy that was ineffective or caused a diminished effect or adverse event. This law is effective for policies delivered, issued or renewed on or after Jan. 1, 2018.

HB 233 »