This bill, HB 1638-FN, introduces a new mechanism for bypassing health insurer step therapy protocols when a prescription drug is deemed medically necessary. It amends RSA 420-J by adding a new subdivision that defines key terms such as "advanced, metastatic cancer," "medically necessary," and "step therapy protocol." The legislation outlines the criteria for granting override exceptions to step therapy, emphasizing the importance of clinical practice guidelines based on high-quality studies developed by a multidisciplinary panel. It mandates that health carriers must approve or deny override requests within specified timeframes—7 days for electronic submissions and 14 days for non-electronic submissions, with a 24-hour response time for urgent requests. If a required prescription drug is contraindicated, ineffective, or not in the patient's best interest, an override exception must be granted.

Additionally, the bill prohibits step therapy protocols for certain prescription drugs used to treat advanced, metastatic cancer, provided they are supported by evidence-based literature and FDA-approved. It requires carriers or utilization review organizations to notify patients and their healthcare providers of the determination regarding the override request within 72 hours. While the bill aims to enhance patient access to necessary medications, it imposes new administrative requirements on health carriers, which may lead to increased operational costs and potentially higher health insurance premiums. The fiscal impact of the bill is indeterminable, as it is unclear how many exception requests will be made or how carriers will adjust their processes and pricing strategies in response to the new requirements.