The proposed bill, Substitute Bill No. 331, aims to amend the step therapy requirements for prescription drugs covered under the Medicaid program and enhance notification procedures for enrollees regarding payment suspensions, denials, or new requirements. Specifically, it repeals the existing language in subsection (b) of section 17b-274f, replacing it with provisions that allow the duration of step therapy programs to follow evidence-based guidelines from drug manufacturers and the FDA. If no such guidelines are available, the step therapy period is limited to thirty days, after which a prescribing practitioner can determine the treatment as clinically ineffective, allowing for the prescribed drug to be covered under Medicaid.

Additionally, the bill introduces new requirements for the Department of Social Services or its contracted entities to provide timely written notices to HUSKY Health plan enrollees affected by payment denials or new step therapy requirements. These notices must be delivered within specified timeframes, including immediate notification at the pharmacy for denied electronic payment requests and advance notice for planned suspensions or new requirements. The notices are required to be clear and informative, detailing the new requirements and the enrollee's rights to due process and appeals under applicable federal and state laws.