This bill revises health care laws in Montana by establishing specific protocols for step therapy, which requires patients to try certain medications before being approved for others. It introduces new definitions such as "step therapy exception determination" and "step therapy protocol," outlining conditions for bypassing standard requirements. The bill mandates that clinical review criteria for these protocols 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, with specific circumstances under which exceptions must be granted, and requires insurers to make determinations within specified timeframes.

Additionally, the bill imposes new regulations on insurers and utilization review organizations, mandating that they authorize coverage for prescribed medications upon granting a step therapy exception. It requires annual certification to the state commissioner of securities and insurance for compliance with established protocols and mandates prior approval for any changes to these protocols. Insurers must also submit an annual report to the state auditor detailing step therapy exception requests and their outcomes. The bill clarifies its applicability to all state-regulated health insurance plans covering prescription drugs under a step therapy protocol and allows insurers to require patients to try generic equivalents before name-brand drugs, provided it aligns with step therapy exception criteria. The bill is intended to be codified as part of Title 33, chapter 32, part 2.

Statutes affected:
LC Text: 33-32-102