Step Therapy Protocols Must Be Established

On May 24, 2017, Gov. Abbott signed SB 680 into law, which mandates certain actions in regards to step therapy protocols. As background, step therapy protocol means issuers require plan participants to use certain prescription drugs (other than prescription drugs recommended by participants’ health-care providers) or to take prescription drugs in a certain order before plans provide coverage for recommended prescription drugs.

This bill requires insurers that require step therapy before providing prescription drugs to establish, implement and administer the step therapy protocol in accordance with industrywide clinical review criteria. The insurer must also take atypical patient populations and diagnosis into account when developing the criteria.

Additionally, the bill requires that conflicts of interests be managed by a multidisciplinary expert, including physicians and other health providers, and that plan participants and health-care practitioners be able to request step therapy protocol exceptions through a user-friendly process.

This law will become effective for plans delivered, issued for delivery or renewed on or after Jan. 1, 2018.

SB 680 »