June 1, 2016

On Mar. 29, 2016, Gov. Tomblin signed HB 4040 into law. The legislature found that health plans were increasingly including step therapies that require patients to try one or more prescription drugs before providing coverage for a drug selected by the patient’s health care provider and these protocols may have adverse or dangerous consequences for the patient. The law establishes uniform policies for exemptions to step therapy protocols and an expeditious process for patients to request an override to the plan’s step therapy protocols.

This law applies to group health benefit plans that include prescription drug benefits and pharmacy benefit managers administering fully-insured or self-insured plans. The law goes into effect for plans issued for delivery, delivered, renewed or otherwise contracted in the state on or after July 1, 2016.

HB 4040 »