Senate Bill No. introduced by E. Boldman aims to revise health care laws by establishing specific protocols for step therapy, which requires patients to try certain medications before being approved for more expensive options. The bill amends Section 33-32-102 of the Montana Code Annotated (MCA) to introduce new definitions such as "step therapy exception determination" and "step therapy protocol." These definitions outline the conditions under which a patient can bypass standard step therapy requirements. The bill mandates that clinical review criteria for these protocols must be based on evidence-based clinical practice guidelines developed by a multidisciplinary panel of experts. It also ensures that patients and healthcare providers have access to a clear process for requesting step therapy exceptions, which must be easily accessible on the insurer's or utilization review organization's website.

Additionally, the bill requires insurers to authorize coverage for prescribed medications upon granting a step therapy exception and mandates annual certification to the state commissioner of securities and insurance regarding compliance with step therapy protocols. Insurers must also submit an annual report to the state auditor detailing the number of step therapy exception requests and their outcomes. The bill clarifies that it applies to all state-regulated health insurance plans with prescription drug coverage and allows insurers to require patients to try generic equivalents before covering name-brand drugs, provided it aligns with established criteria for exceptions. Overall, the bill seeks to enhance patient access to necessary medications while ensuring fair and transparent application of step therapy protocols.

Statutes affected:
LC Text: 33-32-102
SB0483_1(1): 33-32-102
SB0483_1(2): 33-32-102
SB0483_1: 33-32-102