HF 233 — A bill for an act relating to the use of step therapy protocols for prescription drugs by health carriers, health benefit plans, and utilization review organizations, and including applicability provisions. (Formerly HSB 26.) Effective 7-1-17.

House File 233 - ReprintedEnrolled HOUSEHouse FILEFile 233 BYAN COMMITTEEACT ONRELATING HUMAN RESOURCES (SUCCESSOR TO HSBTHE 26)USE (AsOF AmendedSTEP andTHERAPY PassedPROTOCOLS by the House March 27, 2017) A BILL FOR AnPRESCRIPTION ActDRUGS relatingBY toHEALTH theCARRIERS, useHEALTH ofBENEFIT stepPLANS, therapyAND protocolsUTILIZATION forREVIEW prescriptionORGANIZATIONS, drugsAND byINCLUDING healthAPPLICABILITY carriers,PROVISIONS. health benefit plans, and utilization review organizations, and including applicability provisions.

HFSection 2331. (4) 87 av/nh/md H.F.

233 Section 1.

d.House File 233, p.

2 d.

“Pharmaceutical sample” means a unit of a prescription drug that is not intended to be sold and is intended to promote HFthe 233sale (4)of 87the -1-drug. av/nh/md 1/5 H.F.

233 the sale of the drug.

“Step therapy protocol” means a protocol or program that establishes a specific sequence in which prescription drugs for a specified medical condition and medically appropriate for a particular covered person are covered under a pharmacy or medical benefit by a health carrier, a health benefit plan, or aHouse utilizationFile review233, organization,p. including self-administered drugs and drugs administered by a health care professional.

3 a utilization review organization, including self-administered drugs and drugs administered by a health care professional.

A health carrier, health benefit plan, or utilization review HForganization 233shall (4)consider 87available -2-recognized av/nh/mdevidence-based 2/5and H.F.peer-reviewed clinical practice guidelines when establishing a step therapy protocol.

233 organization shall consider available recognized evidence-based and peer-reviewed clinical practice guidelines when establishing a step therapy protocol.

The process usedHouse shallFile be233, easilyp. accessible on the internet site of the health carrier, health benefit plan, or utilization review organization.

4 used shall be easily accessible on the internet site of the health carrier, health benefit plan, or utilization review organization.

HF(c) 233Cause (4)physical 87or -3-mental av/nh/mdharm 3/5to H.F.a covered person.

233 (c) Cause physical or mental harm to a covered person.

(3) The covered person has had a trial of a therapeutically equivalent dose of the prescription drug under the step therapy protocol while under the covered person’s current or previous health benefit plan for a period of time to allow for a positive treatment outcomeoutcome, or of another prescription drug in the same pharmacologic class or with the same mechanism of action, and such prescription drug was discontinued by the covered person’s health care professional due to lack of effectiveness.

(4) The covered person is currently receiving a positive therapeutic outcome on a prescription drug selected by the covered person’s health care professional for the medical conditionHouse underFile consideration233, whilep. under the covered person’s current or previous health benefit plan.

5 condition under consideration while under the covered person’s current or previous health benefit plan.

Upon approval of a step therapy override exception, the health carrier, health benefit plan, or utilization review organization shall authorize coverage for the prescription drug selected by the covered person’s prescribing health care professional if the prescription drug is a covered prescription HFdrug 233under (4)the 87covered -4-person’s av/nh/mdhealth 4/5benefit H.F.plan.

233 drug under the covered person’s health benefit plan.

b.House File 233, p.

6 b.

HF______________________________ 233______________________________ (4)LINDA 87UPMEYER -5-JACK av/nh/mdWHITVER 5/5Speaker of the House President of the Senate I hereby certify that this bill originated in the House and is known as House File 233, Eighty-seventh General Assembly.

______________________________ CARMINE BOAL Chief Clerk of the House Approved _______________, 2017 ______________________________ TERRY E.

BRANSTAD Governor