Substitute Senate Bill No. 182 (sSB182 File No. 20) introduces changes to current law by restricting health carriers from mandating step therapy for prescription drugs used to treat mental or behavioral health conditions, or chronic, disabling, or life-threatening conditions, provided the drugs are FDA-approved for those indications. Step therapy, which requires patients to try less expensive drugs before being prescribed more costly alternatives, will now have a reduced mandatory duration from thirty to twenty days for other medical conditions. The bill also streamlines the override process for step therapy, shortening the response time from sixty to twenty days and mandating health carriers to establish a user-friendly override process for health care providers. The override must be granted promptly when certain conditions are met, such as previous ineffectiveness or potential harm to the patient. The bill ensures that the override process is communicated to health care providers and that the prescribed drug is authorized for dispensation and coverage if it is included in the policy or contract. These provisions are set to take effect on January 1, 2025.

The financial implications of the bill indicate that it may lead to higher premiums for the state employee health plan due to increased per member per month costs, which would affect the State Comptroller - Fringe Benefits account. Municipalities that have self or fully insured health plans might also incur higher costs. The fiscal impact statement included in the bill suggests that the elimination of step therapy for certain conditions and the reduced timeframe for step therapy for all other conditions will likely result in higher claim costs for the state and municipalities. This fiscal impact is expected to persist and may increase with inflation over time.