How HB1638 changes current law

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.