New Hampshire 2026 Session Status: Introduced Bipartisan · 6 R · 3 D cosponsors

HB1638 — creating a bypass mechanism for health insurer step therapy protocols when medically necessary.

Last action — INTERIM STUDY

  1. 1
    Introduced
  2. 2
    In Committee
  3. 3
    Passed House
  4. 4
    Passed Senate
  5. 5
    To Executive
  6. 6
    Enacted

This bill has been introduced in the House. Introduced December 10, 2025. It must pass committee before a floor vote.

Next likely step: a committee referral and hearing.

Odds of enactment

Low chance

Based on the sponsor, cosponsors, and committee posture, this bill has a low chance of becoming law.

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A statistical estimate from our own model of past outcomes — an insight, not a guarantee. Policymaking is volatile.

Prognosis

Advancing 34% · moderate confidence

  • Introduced

    Current position in the legislative process.

  • 9 sponsors

    1 primary, 8 co-sponsors signed on.

  • Bipartisan support

    Sponsored across 2 parties (6 R · 3 D) — cross-party backing.

Based on stage, sponsorship breadth, committee status, recorded votes, and cross-state momentum — a description of the observable signals, not a prediction.

Summary

creating a bypass mechanism for health insurer step therapy protocols when medically necessary.

Bill Text

How this bill changes current law

5 changes Share ↗

AI-generated reading aid from the bill's amendatory text — verify against the official bill.

This bill creates a new process for bypassing step therapy protocols in health insurance when deemed medically necessary.

  • RSA 420-J

    New subdivision for Step Therapy including sections 420-J:27 to 420-J:34.

    Establishes a new set of definitions and processes for step therapy protocols.

  • 420-J:32

    I. When coverage of a prescription drug for the treatment of any medical condition is restricted for use by a carrier or utilization review organization through the use of a step therapy protocol, the enrollee and prescriber shall have access to a clear, readily accessible and convenient process to request a step therapy override exception determination from that carrier or utilization review organization.

    Mandates a clear process to request an override of step therapy protocols.

  • 420-J:33

    Step therapy protocols shall be prohibited for certain prescription drugs to treat advanced, metastatic cancer and associated conditions.

    Prohibits step therapy protocols for certain drugs used in treating advanced cancer.

  • 420-J:32 III

    A carrier or utilization review organization shall expeditiously grant a step therapy override exception determination if: (a) The required prescription drug is contraindicated or will likely cause an adverse reaction in or physical or mental harm to the enrollee; (b) The required prescription drug is expected to be ineffective based on the known clinical characteristics of the enrollee and the known characteristics of the prescription drug regimen; (c) The enrollee has tried the required prescription drug while under the enrollee's current or previous health insurance or health plan, or another prescription drug in the same pharmacologic class or with the same mechanism of action, and the prescription drug was discontinued due to lack of efficacy or effectiveness, diminished effect or an adverse reaction; (d) The required prescription drug is not in the best interest of the enrollee, based on medical necessity; (e) The enrollee is stable on a prescription drug selected by the enrollee's health care provider for the medical condition under consideration while on a current or previous health insurance or health plan; or (f) The prescription drug selected by the enrollee's health care provider is intended to assess or treat the enrollee's serious mental illness.

    Specifies conditions under which a step therapy override determination must be granted.

  • 420-J:34

    The commissioner may adopt rules, pursuant to RSA 541-A, to assist the insurance department with the implement this section.

    Gives the commissioner authority to create rules for implementing the step therapy protocols.

Action History

  1. Executive Session: 10/14/2026 10:00 am GP 229

  2. Subcommittee Work Session: 10/07/2026 10:00 am GP 229

  3. Subcommittee Work Session: 09/09/2026 10:00 am GP 229

  4. Public Hearing: 02/17/2026 11:00 am GP 159

  5. Refer for Interim Study: MA VV 03/11/2026 HJ 7 P. 13

  6. Committee Report: Refer for Interim Study 02/18/2026 (Vote 15-0; CC) HC 10 P. 9

  7. Full Committee Work Session: 02/18/2026 10:00 am GP 229

  8. Executive Session: 02/18/2026 01:00 pm GP 229

  9. Introduced 01/07/2026 and referred to Commerce and Consumer Affairs HJ 1 P. 29

Sponsors

Sponsorship breakdown

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1 sponsors · 8 co-sponsors · 406 not signed on

Sponsors (1)

Co-sponsors (8)

Not signed on (406)

406 members have not signed on to this bill.

Show all 406 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Subjects

healthcare health-insurance
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

What does HB1638 do?
creating a bypass mechanism for health insurer step therapy protocols when medically necessary.
Who sponsors HB1638?
HB1638 is sponsored by Julie Miles (Republican), Lilli Walsh (Republican), David Nagel (Democrat), Wayne MacDonald (Republican), Cindy Rosenwald (Democrat), Kevin Avard (Republican), David Lundgren (Republican), Mark Pearson (Republican), and Gary Woods (Democrat).
What is the current status of HB1638?
This bill has been introduced in the House. Introduced December 10, 2025. It must pass committee before a floor vote.
Where can I track HB1638?
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