Senate Bill No. [insert bill number] aims to revise health care laws in Montana by establishing specific protocols for step therapy, which requires patients to try certain medications before being approved for others. The bill introduces new definitions such as "step therapy exception determination" and "step therapy protocol," outlining conditions for bypassing standard requirements. It mandates that clinical review criteria for these protocols be based on evidence-based guidelines developed by a multidisciplinary panel, ensuring transparency and regular updates. The bill also ensures that patients and healthcare providers have access to a clear process for requesting exceptions, which must be available on the insurer's or review organization's website. Specific circumstances for granting exceptions are outlined, including when a patient is stabilized on a medication or when the required medication is contraindicated or ineffective.

Additionally, the bill requires insurers and utilization review organizations to authorize coverage for prescribed medications upon granting a step therapy exception and mandates annual certification to the state commissioner of securities and insurance for compliance. Changes to step therapy protocols must receive prior approval from the commissioner, and annual reports detailing exception requests and outcomes must be submitted to the state auditor. The bill clarifies its applicability to all state-regulated health insurance plans with prescription drug coverage 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, ensuring that its provisions are integrated into existing regulations.

Statutes affected:
LC Text: 33-32-102
SB0483_1(1): 33-32-102
SB0483_1(2): 33-32-102
SB0483_1(3): 33-32-102
SB0483_1(4): 33-32-102
SB0483_1(5): 33-32-102
SB0483_1: 33-32-102